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CRF: Key Facts (Ix (Renal Screen ( Immune ( SLE: ANA, C3, C4, …

- - - - Normal = <20mg/mM
      - Nephrotic = >300mg/mM
  - - - SLE: ANA, C3, C4
      - Goodpasture’s: anti-GBM
      - Vasculitis: ANCA
      - Hepatitis: viral serology
  - - - Usually small (<9cm)
      - May be large: polycystic, amyloid
- - - - Rx reversible causes
      - Stop nephrotoxic drugs
      - Na, K, fluid and PO4 restriction
      - Optimise CV Risk
        
        Smoking cessation, exercise
        Statin + antiplatelet, Rx DM
    - - Hypertension
        
        Target <140/90 (<130/80 if DM)
        
        In DM kidney disease give ACEi/ARB (inc. if normal BP)
      - Oedema: frusemide
      - Bone Disease
        
        Phosphate binders: calcichew, sevelamer
        
        Vit D analogues: alfacalcidol (1 OH-Vit D3)
        
        Ca supplements
        
        Cinacalcet: Ca mimetic
      - Anaemia
        
        Exclude IDA and ACD
        
        EPO to raise Hb to 11g/dL (higher = thrombosis risk)
      - Restless Legs: clonazepam
- - - - CTD: SLE, SS, RA
      - Polycystic disease
      - Drugs: e.g. analgesic nephropathy
      - Pyelonephritis: usually 2O to VUR
      - Myeloma and amyloidosis
      - GN
      - RAS
- - - - 30-300mg/d or albumin:creatinine >3mg/mM
      - Strong independent RF for CV disease
- - - - Immune complex deposition → T3 hypersensitivity
      - Typically membranous GN
      - Proteinuria and ↑BP