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Renal History
 
 

Chronic Kidney Disease

 
 
 
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Overview

  • Ask About

  • 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 - commencement, modality, access, timing, fluid removal

Diagnosis

  • 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

  • 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 / anaemia of chronic disease)
  • 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

  • Management Strategy

  • 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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