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CKD FOR FINALS

CKD FOR FINALS. Dr H. Elcome, FY1 Dr K. Thompson, FY1. “ Long term disease of the kidneys, causing either albuminuria or reduced function (eGFR) ”. Plan. Case Aetiology History and Examination Investigations Management Conservative Medical Surgical Complications.

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CKD FOR FINALS

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  1. CKD FOR FINALS Dr H. Elcome, FY1 Dr K. Thompson, FY1

  2. “ Long term disease of the kidneys, causing either albuminuria or reduced function (eGFR) ”

  3. Plan Case Aetiology History and Examination Investigations Management Conservative Medical Surgical Complications

  4. Learning objectives • Recognising stigmata of CKD • Investigations for CKD • Management plan in CKD • Pros/cons of RRT

  5. Case A 58 yr old man presents to his GP with a history of feeling generally unwell and lethargic for six months but has not sought medical attention until now. He has reduced exercise tolerance and feels nauseous. What other questions would you like to ask?

  6. Case On further questioning you find he complains of: Puritus resistant to Piriton Generalised aching in his joints and back Increased thirst A yellowing of the skin

  7. Case On Examination: BP 160/95 Jaundice with excoriated skin CV/Resp NAD What tests would you like to order?

  8. Case Bloods: Na: 143 (135-145) K: 5.8 (3.5-5.2) Ur: 55 (6-20) Cr: 398 (60-110)

  9. Case

  10. Case What would your management plan be?

  11. Aetiology • PRE-RENAL • Atherosclerosis • Heart Failure • HTN • RENAL • Congenital • PCKD • Glomerular/Tubular • SLE/Vasculitides • Amyloidosis • Drug overdoses • Diabetes • POST-RENAL • Outflow tract obstruction • BPH

  12. Staging

  13. PCKD • COMMON FPE CASE! • Usually Autosomal, Dominant • (rarer recessive Childhood PCKD) • Other organs: • Liver • Pancreas • Heart valves • Mitral Regurge. • Aneurysms (CoW) • SA haemorrhage

  14. History and Examination • What are the main functions of the kidney? • Excretion • Filtration • Elimination • Via the urine • Regulation • BP Regulation RAAS • Electrolyte balance • Vitamin D • Calcidiol->Calcitriol • Erythropoietin

  15. History and Examination Anaemia Pallor, SOBOE, Malaise and lethargy Hypertension Signs of fluid overloading Excretion Pruritus, jaundice Electrolyte imbalance Potassium Sodium Headaches, nausea # due to osteomalacia Urinary symptoms Ask about immunosuppressants

  16. Don’t forget... • In the OSCE, do not forget to look and feel for 1. A/V Fistulae • 2. Renal Transplant scar/organ

  17. Investigations • Bedside • ECG (CV disease) • Urine dip • Bloods • U&E’s and eGFR • FBC • ESR (Long term inflammation) • Calcium (down) • Phosphate (up) • Urate (up) • Imaging • USS • CT KUB • X-ray (Chest, abdo) • Biopsy

  18. Investigations- eGFR • 1. Age • 2. Sex • 3. Race • 4. Serum Creatinine

  19. Management...Conservative Reduce dietary sodium Reduce dietary potassium

  20. Management...Medical EPO Antihypertensives (ACEI, diuretic, CCB) Calcium supplements (PO4 binders) Vitamin D RRT -Haemodialysis -Peritoneal dialysis -Haemofiltration -Transplantation

  21. Dialysis Haemodialysis Semi-permeable membrane Time consuming Travel to hospital Requires AV fistulae Peritoneal Dialysis Permanent catheter 3L of fluid; uncomfortable Higher infection risk (SBP)

  22. Transplant

  23. Complications • Anaemia • Renal osteodystrophy • Myopathy • Neuropathy • CVD • Infection (immunocompromise)

  24. Questions?

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