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Cardio History

Chronic Kidney Disease



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    • Diagnosis - cause of chronic kidney disease, stage
    • Complications - acidosis, fluid overload, electrolyte derangements, cardiovascular disease, anaemia, mineral bone disease, malnutrition
    • Management - management of complications, dialysis, renal transplant
    • Dialysis - copmmencement, modality, access, timing, fluid removal


    • Causes of Chronic Kidney Disease

    • Diabetic nephropathy
    • Hypertensive nephropathy
    • Glomerulonephritis
    • Tubulointerstitial disease - analgesic nephropathy, reflux nephropathy
    • Congenital disease - polycystic kidney disease
    • Stages of Chronic Kidney Disease

    • GFR Categories (mL/min/1.73m²)

    • G1 - ⩾90
    • G2 - 60-89
    • G3a - 45-59
    • G3b - 30-44
    • G4 - 15-29
    • G5 - <15
    • Albuminuria Categories

    • A1 - <30mg/g / <3mg/mmol
    • A2 - 30-300mg/g / 3-30mg/mmol
    • A3 - >300mg/mg / >30mg/mmol


    • Complications of Chronic Kidney Disease

    • Disease-Related

    • Acidosis (poor clearance of hydrogen ions)
    • Fluid overload
    • Electrolyte derangements - hyperkalaemia, hyperphosphataemia
    • Cardiovascular disease - hypertension, increased cardiovascular / cerebrovascular risk
    • Anaemia (EPO deficiency)
    • Mineral bone disease (mediated by FGF23) - secondary hyperparathyroidism, hyperphosphataemia, hypocalcaemia; tertiary hyperparathyroidism
    • Uraemia - encephalopathy, uraemic pericarditis
    • Malnutrition
    • Treatment-Related

    • Lethargy
    • Muscle cramps
    • Restless legs syndrome
    • Access-related complications - thrombosis, infection


    • Management Strategies

    • Slow Progression

    • Treat the cause of CKD - e.g. diabetes, hypertension
    • ACE inhibitors - captopril, perindopril, ramipril
    • Angiotensin II receptor blockers - candesartan, irbesartan, telmisartan
    • Treat Complications

    • Acidosis - consider sodium bicarbonate
    • Fluid overload - fluid restriction, salt restriction
    • Anaemia - iron replacement if required, consider EPO
    • Cardiovascular disease - control hypertension, statin, consider aspirin
    • Mineral bone disease - dietary phosphate restriction, phosphate binders (calcium / non-calcium-based), calcitriol, parathyroidectomy
    • Malnutrition - high protein intake
    • Other

    • Dialysis - consider when to start and what modality
    • Renal transplant - consider suitability
  • Most patients with chronic kidney disease will die due to cardiovascular disease, so it is important to manage the risk factors of this.
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 Abbott AV. Diagnostic approach to palpitations. Am Fam Physician. 2005 Feb 15;71(4):743-50. Arthur W, Kaye GC. The pathophysiology of common causes of syncope. Postgraduate medical journal. 2000 Dec 1;76(902):750-3. Benditt DG. Neurally mediated syncopal syndromes: pathophysiological concepts and clinical evaluation. Pacing and clinical electrophysiology. 1997 Feb 1;20(2):572-84. Cayley J,William E. Chest pain--tools to improve your in-office evaluation. J Fam Pract. 2014;63:246.
Constant J. The diagnosis of nonanginal chest pain.  Keio J Med. 1990;39:187-192.
 Cotter L. History and Examination of the Cardiovascular System. Medicine. 2010; 38(7): 344-347. Eriksson B, Vuorisalo D, Sylven C. Diagnostic potential of chest pain characteristics in coronary care.  J Intern Med. 1994;235:473-478 Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. International journal of hypertension. 2011 Mar 2;2011.
Kass S. Pleurisy. Am Fam Physician. 2007;75:1357.
 Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. Jama. 2003 Aug 20;290(7):898-904. Kim EJ, Kim BH, Seo HS, Lee YJ, Kim HH, Son HH, Choi MH. Cholesterol-induced non-alcoholic fatty liver disease and atherosclerosis aggravated by systemic inflammation. PloS one. 2014 Jun 5;9(6):e97841. Mak SM, Strickland N, Gopalan D. Complications of pulmonary hypertension: a pictorial review. The British journal of radiology. 2017 Feb;90(1070):20160745.
Miller TH, Kruse JE. Evaluation of syncope. Am Fam Physician. 2005 Oct 15;72(8):1492-500.
Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007 Sep 1;93(9):1137-46.
 National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012.
Onusko E. Diagnosing secondary hypertension. American family physician. 2003 Jan;67(1):67-74.
 Payne RA. Cardiovascular Risk. British Journal of Clinical Pharmacology. 2012; 74(3): 396-410. Petersen P. Thromboembolic complications in atrial fibrillation. Stroke. 1990 Jan;21(1):4-13.
Schoenkerman A, Goldschlager N. Chest Pain: Does This Patient Have Cardiac Ischaemia? Consultant. 2013; 53(8): 556-560.
 Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Sanchez MA, Kumar RK, Landzberg M, Machado RF, Olschewski H. Updated clinical classification of pulmonary hypertension. Journal of the American College of Cardiology. 2013 Dec 24;62(25 Supplement):D34-41. Susanto M. Dizziness: if not vertigo could it be cardiac disease?. Australian family physician. 2014 May;43(5):264. Swap CJ, Nagurney JT. Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes. JAMA. 2005;294:2623-2629. Vodnala D, Rubenfire M, Brook RD. Secondary causes of dyslipidemia. The American journal of cardiology. 2012 Sep 15;110(6):823-5. Wahls SA. Causes and evaluation of chronic dyspnea. American family physician. 2012 Jul 15;86(2). Watson RD, Gibbs CR, Lip GY. ABC of heart failure: clinical features and complications. BMJ: British Medical Journal. 2000 Jan 22;320(7229):236. Weber BE, Kapoor WN. Evaluation and outcomes of patients with palpitations. The American journal of medicine. 1996 Feb 29;100(2):138-48.
Wexler RK, Pleister A, Raman S. Outpatient approach to palpitations. heart disease. 2011 Jul 1;100:6.
 Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. Cmaj. 2007 Apr 10;176(8):1113-20. Zimetbaum P, Josephson ME. Evaluation of patients with palpitations. New England Journal of Medicine. 1998 May 7;338(19):1369-73.