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

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

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

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

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 ( ) K: 5.8 ( ) Ur: 55 (6-20) Cr: 398 (60-110)

Case

What would your management plan be?

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

Staging StageeGFR 1> a 3b < 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

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 History and Examination

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 – 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 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 Anaemia Renal osteodystrophy Myopathy Neuropathy CVD Infection (immunocompromise)

Questions?