Transcript CKD presentation (Keri and Hannah)

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
Learning objectives
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Recognising stigmata of CKD
Investigations for CKD
Management plan in CKD
Pros/cons of RRT
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?
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
Case
On Examination:
BP 160/95
Jaundice with excoriated skin
CV/Resp NAD
What tests would you like to order?
Case
Bloods:
Na: 143 (135-145)
K: 5.8 (3.5-5.2)
Ur: 55 (6-20)
Cr: 398 (60-110)
Case
Case
What would your management plan be?
Aetiology
• PRE-RENAL
– Atherosclerosis
– Heart Failure
– HTN
• RENAL
– Congenital
• PCKD
– Glomerular/Tubular
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SLE/Vasculitides
Amyloidosis
Drug overdoses
Diabetes
• POST-RENAL
– Outflow tract obstruction
• BPH
Staging
Stage
eGFR
1
> 90
2
60-89
3a
3b
45-59
30-44
4
15-29
5
< 15 or on Renal
Replacement Therapy
PCKD
• COMMON FPE CASE!
•Usually Autosomal, Dominant
•(rarer recessive Childhood PCKD)
•Other organs:
•Liver
•Pancreas
•Heart valves
•Mitral Regurge.
•Aneurysms (CoW)
•SA haemorrhage
History and Examination
• What are the main functions of the
kidney?
1. Excretion
Filtration
2. Elimination
Via the urine
3. Regulation
BP Regulation RAAS
Electrolyte balance
Vitamin D
Calcidiol->Calcitriol
Erythropoietin
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
Don’t forget...
• In the OSCE, do not forget to look and feel for
1. A/V Fistulae
2. Renal Transplant scar/organ
Investigations
• Bedside
– ECG (CV disease)
– Urine dip
• Bloods
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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
Investigations- eGFR
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1. Age
2. Sex
3. Race
4. Serum Creatinine
Management...Conservative
Reduce dietary sodium
Reduce dietary potassium
Management...Medical
EPO
Antihypertensives (ACEI, diuretic, CCB)
Calcium supplements (PO4 binders)
Vitamin D
RRT
-Haemodialysis
-Peritoneal dialysis
-Haemofiltration
-Transplantation
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)
Transplant
Complications
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Anaemia
Renal osteodystrophy
Myopathy
Neuropathy
CVD
Infection (immunocompromise)
Questions?