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

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

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. 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 StageeGFR 1> 90 260-89 3a 3b 45-59 30-44 415-29 5< 15 or on Renal Replacement Therapy

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? 1.Excretion Filtration 2.Elimination Via the urine 3.Regulation BP Regulation RAAS Electrolyte balance Vitamin D Calcidiol->Calcitriol Erythropoietin

15. 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

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?