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Chronic Kidney Disease (Aetiology (Amyloidosis, Hypertensive…
Chronic Kidney Disease
Key Facts
CKD is longstanding, usually progressive, impairment in renal function (haematuria, proteinuria or anatomically abnormality) for more than 3 months
Defined as a GFR < 60ml/min/1.73m2 for more than 3 months with/without evidence of kidney damage (haematuria, proteinuria or anatomical abnormality
Intervening early in CKD can reduce progression to end-stage renal failure (ESFR) and so screening is recommended to at risk patients
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Risk Factors
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African, Afro-Caribbean or Asian origin
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Pathophysiology
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In CKD, where many nephrons have failed, and scarred, the burden of filtration falls to fewer functioning nephrons
CKD tends to progress to end-stage kidney disease,
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Clinical Presentation
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Nausea, vomiting and diarrhoea
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Increased risk of peptic ulceration, acute pancreatitis, hyperuricaemia and incidence of malignancy
Complications
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Cardiovascular disease - highest mortality is from CVD due to hyperlipidaemia and vascular calcification
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Differential Diagnosis
Acute Kidney Injury
To differentiate it depends on history, duration of symptoms and previous urinalysis or measurement of serum creatinine
A normochromic anaemia, small kidneys on ultrasound and the presence of renal osteodystrophy favour CKD
Diagnosis
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Bloods - raised phosphate, low Ca
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Urinalysis - mid-stream urine sample sent for microscopy and sensitivity, albumin to creatinine ratio
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Treatment
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Renal replacement therapy - haemodialysis, peritoneal dialysis
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