Download - CKD FOR FINALS
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CKD FOR CKD FOR FINALSFINALS
Dr H. Elcome, FY1Dr H. Elcome, FY1Dr K. Thompson, FY1Dr K. Thompson, FY1
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“
Long term disease of the kidneys, causing either albuminuria or reduced function (eGFR)
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Case AetiologyHistory and ExaminationInvestigationsManagement
ConservativeMedicalSurgical
Complications
Plan
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• Recognising stigmata of CKD• Investigations for CKD• Management plan in CKD• Pros/cons of RRT
Learning objectives
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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?
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Case
On further questioning you find he complains of:
Puritus resistant to PiritonGeneralised aching in his joints and backIncreased thirstA yellowing of the skin
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Case
On Examination:
BP 160/95Jaundice with excoriated skinCV/Resp NAD
What tests would you like to order?
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Case
Bloods:
Na: 143 (135-145)K: 5.8 (3.5-5.2)Ur: 55 (6-20)Cr: 398 (60-110)
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Case
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Case
What would your management plan be?
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Aetiology• PRE-RENAL
– Atherosclerosis– Heart Failure– HTN
• RENAL– Congenital
• PCKD– Glomerular/Tubular
• SLE/Vasculitides• Amyloidosis• Drug overdoses• Diabetes
• POST-RENAL– Outflow tract obstruction
• BPH
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StagingStage eGFR
1 > 90
2 60-89
3a3b
45-5930-44
4 15-29
5 < 15 or on Renal Replacement Therapy
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PCKD
• COMMON FPE CASE!•Usually Autosomal, Dominant •(rarer recessive Childhood PCKD)
•Other organs:•Liver•Pancreas•Heart valves•Mitral Regurge.
•Aneurysms (CoW)•SA haemorrhage
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History and Examination
• What are the main functions of the kidney?
1. ExcretionFiltration
2. EliminationVia the urine
3. RegulationBP Regulation RAASElectrolyte balanceVitamin D
Calcidiol->CalcitriolErythropoietin
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AnaemiaPallor, SOBOE, Malaise and lethargy
HypertensionSigns of fluid overloading
ExcretionPruritus, jaundice
Electrolyte imbalancePotassiumSodium
Headaches, nausea
# due to osteomalacia
Urinary symptoms
Ask about immunosuppressants
History and Examination
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Don’t forget...
• In the OSCE, do not forget to look and feel for
1. A/V Fistulae
2. Renal Transplant scar/organ
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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
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Investigations- eGFR
• 1. Age• 2. Sex• 3. Race• 4. Serum Creatinine
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Management...Conservative
Reduce dietary sodiumReduce dietary potassium
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Management...MedicalEPOAntihypertensives (ACEI, diuretic, CCB)Calcium supplements (PO4 binders)Vitamin D
RRT-Haemodialysis-Peritoneal dialysis-Haemofiltration-Transplantation
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Dialysis
HaemodialysisSemi-permeable membraneTime consumingTravel to hospitalRequires AV fistulae
Peritoneal DialysisPermanent catheter3L of fluid; uncomfortableHigher infection risk (SBP)
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Transplant
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Complications
• Anaemia • Renal osteodystrophy• Myopathy• Neuropathy• CVD• Infection (immunocompromise)
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Questions?