Renal History
 

Chronic Kidney Disease

 
 
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Overview

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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 - 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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