Chronic kidney disease - Revision history

Aidan: /* Management */

2023-05-02T14:08:04Z

Management

@@ Line 76: / Line 76: @@
 *Metabolic acidosis (normal anion gap)
 **Oral sodium bicarbonate 0.5-1 mEq/kg/d to maintain bicarb between 23-29 mmol/L
 *Avoid nephrotoxic mediation like NSAIDs
 ===Complications===
@@ Line 100: / Line 127: @@
 **30 year olds on dialysis have same risk as 80 year olds in the general population
 **Risk increases with a decreasing GFR
 [[Category:Nephrology]]

Aidan: /* KDIGO Classification */

2020-08-02T20:04:40Z

KDIGO Classification

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
 ===Definition===
@@ Line 7: / Line 7: @@
 ===KDIGO Classification===
-Defined as 3 or more months of either GFR &lt; 60 or 1 or more marker of kidney damage:
+* Defined as 3 or more months of either GFR &lt; 60 or 1 or more marker of kidney damage:
-*Grade 2: GFR 60-89 with a marker of kidney disease
+**'''Grade 4:''' GFR 15-29
-*Grade 3a: GFR 45-59
+**'''Grade 5:''' GFR &lt;15, ESRD
 ===Epidemiology===

Aidan: Aidan moved page Chronic renal disease to Chronic kidney disease

2020-08-02T20:03:25Z

Aidan moved page Chronic renal disease to Chronic kidney disease

← Older revision		Revision as of 20:03, 2 August 2020
(No difference)

Aidan at 20:02, 2 August 2020

2020-08-02T20:02:37Z

Show changes

Maintenance script: Imported from text file

2020-07-04T01:17:28Z

Imported from text file

New page

== Definition ==

* Structural or functional kidney disorder lasting at least [3 months]

== KDIGO Classification ==

Defined as 3 or more months of either GFR < 60 or 1 or more marker of kidney damage:

* Proteinuria
* Urine sediments
* Tubular electrolyte disorder
* Kidney transplant
* Structural disease

=== Categories & Grades ===

* Grade 1: GFR ≥90 (normal) with a marker of kidney disease
* Grade 2: GFR 60-89 with a marker of kidney disease
* Grade 3a: GFR 45-59
* Grade 3b: GFR 30-44
* Grade 4: GFR 15-29
* Grade 5: GFR <15, ESRD

[[File:M172640ff1_Appendix_Figure_Prognosis_of_CKD_by_categories_of_GFR_and_albuminuria.jpeg|CKD grade]]

== Epidemiology ==

* 8% of population have GFR < 60
* 4% of population have proteinuria despite normal GFR

== Differential Diagnosis ==

* Diabetes
* Cardiovascular disease/HTN
** Ischemic nephropathy
** Nephrosclerosis
* Glomerulonephritis
* PCKD
* Drugs, especially lithium, cyclosporine, tacrolimus, tenofivir
* Other disease associations
** Inflammatory bowel disease: oxalate nephropathy
** Rheumatoid arthritis: amyloidosis
** Cirrhosis: Type 2 hepatorenal syndrome
** Solid tumours: membranous nephropathy
** Severe CHF: cardiorenal syndrome
** Post-AKI: incomplete recovery of ATN in hospital

== Investigations ==

=== Laboratory ===

* GFR
** MDRD underestimates the GFR in healthy patients
** CKD-Epi is the newer equation and possibly more accurate
** Radioisotopic GFR is the gold standard, inulin clearance is the gold standard for research
** Cystatin C may complement or replace creatinine in the future
* Urinalysis, though "protein" only picks up albumin
* Urine ACR and PCR

=== Imaging ===

* Abdominal ultrasound

== Management ==

* Education re: dialysis and transplant
* Refer to nephrology when:
** GFR drops by 5+ per year
** Acute on chronic kidney injury
** eGFR < 30 (Stage 4)
** Proteinuria >1g/day
** Difficulty controlling BP
* BP control
** ACEi + CCB + diuretic
** If albuminuria, target <130/80, else <140/90
* Proteinuria
** If proteinuria >500mg/d or ACR>30mg/mmol, start ACEi/ARB regardless of BP
** If diabetes and microalbuminuria, start ACEi/ARB
* Metabolic acidosis (normal anion gap)
** Oral sodium bicarbonate 0.5-1 mEq/kg/d to maintain bicarb between 23-29 mmol/L
* Hold ACEi/ARB when AKI, any illness causing dehydration, surgery, contrast study, planning pregnancy
* Avoid nephrotoxic mediation like NSAIDs

=== Complications ===

* '''Anemia:''' treat iron deficiency before adding Epo, targetting 105-115
* '''Hypocalcemia:''' give calcium between meals or rocaltrol (if the hyperphosphatemia is treated)
* '''Hyperphosphatemia:''' give a phosphate binder like calcium or Renagel with meals
* '''Metabolic bone disease:''' maintain normal phosphate with diet, binders, and vitamin D
* '''Acidosis:''' supplement bicarb when < 22
* '''Hyperkalemia''' from poor GFR, ACEi, DM
* '''Pruritis:''' moisturizers, steroids, antihistamines

== Prognosis ==

* GFR declines linearly over time
* Progression predicted by
** Previous rate of progression
** Hypertension **
** Proteinuria **
** Metabolic acidosis
* High risk of cardiovascular mortality compared to general population
** 30 year olds on dialysis have same risk as 80 year olds in the general population
** Risk increases with a decreasing GFR

[[Category:Nephrology]]