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Ckd Rrt Pckd Notes

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Chronic Kidney Disease Stage 1 damage 2 damage 3 damage 4 5

GFR ml/min
>90 Normal GFR + evidence of renal 60-89Slight decrease in GFR + evidence of renal 30-59 Mod decrease in GFR + evidence of renal 15-29 Severe decrease in GFR + ii
<15 Established renal failure

Symptoms usually don't occur until stage 4 is reached ESRF occurs when dialysis or transplant is require to prolong life Causes
- Diabetes
- Chronic glomerulonephritis
- Hypertension (renovascular damage + glomerular loss)
- Polycystic kidney disease
- Pyelonephritis Clinical features (Think of kidney functions
- Fatigue
- N+V
- Anorexia
- Pruritis
- Weight loss
- Restless legs
- Bone pain
- Dyspnoea
- Ankle swelling
- Altered urine output

and then symptoms of its dysfunction)Pallor Yellow skin pigmentation (uraemia) Brown nails Bruising, purpura Excoriation High BP Cardiomegaly Pericardial rub Pulmonary/peripheral oedema

- Bloods o Normocytic, normochromic anaemia, ESR, U+E (raised urea and creatinine) glucose, raised alk phos, phosphate, low calcium, raised PTH
- Urine o MC+S, dipstick, 24hr urinary protein
- Imaging o USS - exclude obstruction, size of kidneys o CXR - cardiomegaly, pleural effusion, pulmonary oedema.
- Biopsy - if normal size kidneys + ? diagnosis Management
- Early referral to nephrologist


Treat reversible causes (e.g obstruction, stop nephrotoxins) Treat calcium levels asap (CVS risk) Hypertension - ACEi + ARB EPO for anaemia Hyperlipidaemia - statin Oedema - loop diuretics + fluid restriction Sodium restricted diet (helps control BP and oedema) Moderate protein intake (avoid malnutrition) Restless legs (gabapentin) Prepare for dialysis/transplant. Counselling and consent

- Increased cardiovascular risk (14/15 patients die of CVS events before ESRF)
- Anaemia o Usually occurs in CKD stage 4 o Due to decreased EPO production and EPO resistance due to uraemia o Treat with EPO injections
- Renal Bone Disease (osteodystrophy) GFR release




Inactive vit D Osteoporosis +
hyperparathyroidism OsteomalaciaNeed phosphate binders e.g calcichew (restrict dietary phosphate - milk, cheese, eggs) Need vit D analogues e.g alfacalcidol Need calcium supplements to decrease bone disease + HPT

NB in CKD prostaglandins maintain blood flow to kidneys - therefore NSAIDS (inhibitors of prostaglandins) can decrease renal function

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