List some Causes/RFs of CKD (Reduced kidney function for >3mths)
- Hypertension, DM, CVD
- AKI, Nephrotoxic drugs, Obstruction
List symptoms of CKD
- Difficulty thinking clearly
- Weight/ Appetite loss
- Dry Itchy skin
- Cramps
- Ankle/ Feet Swelling
- Puffiness around eyes
- Polyuria
- Pale due to anaemia
- Nausea + Vomiting
List complications of CKD
- Fluid retention
- Uraemia
- Hypertension
- Mineral/bone disorder
- End-Stage Renal Disorder
- Anaemia
Suspect CKD if eGFR<60.
List some other investigations
Serum Creatinine, Early morning urine sample for ACR
Dipstick for haematuria
BMI + BP + HbA1c for CVD RFs
Renal USS if needed
Outline the monitoring of CKD
- eGFR, ACR
- FBC for Renal anaemia
- Serum Ca/Phosphate/Vit D/ PTH for Renal Metabolic and Bone disorder
In what situations would you refer someone with CKD to a specialist
- eGFR<30,
- ACR>69 unless pt has DM
- ACR>29 with persistent haematuria after excluding UTI
- Uncontrolled hypertension
- CKD complication
- Suspected renal artery stenosis
Outline the stages of CKD
1: eGFR >89
2: eGFR 60-89
3A: 45-59
3B: 30-44
4: 15-29
5: <15
Outline CKD treatment
- If ACR <30, don’t treat for HyperT
- If ACR >29, ACEi or ARB
- If ACR >2 and Diabetic: ACEi or ARB
- If ACR >70, ACEi/ARB + Refer to specialist, unless diabetic
- Renal replacement therapy (Dialysis- Haemo/ Peritoneal)
- Avoid OTC NSAIDs, Protein supplements, Herbal remedies
Outline BP targets in CKD
- If ACR<70: S <140, D <90
- If Diabetic/ ACR>69: S <130, D <80
How is Accelerated Progression of CKD defined and managed?
- Sustained >25% or >15ml eGFR category chance
- Needs referral after repeating in 2wks to exclude AKI
90% of HyperT pts have a Primary cause
When do you consider a 2ndary cause of HyperT
If <40 (Drugs like Steroids, NSAIDs can cause it)
What do you do if Clinic BP is over 140/80 or 180/120
Over 140/80;
- Offer ABPM/HBPM
- Investigate organ damage
- Assess QRISK
Over 180/120;
- Repeat BP in 7days
- Investigate organ damage
- Refer for same day specialist review
When do you check Sitting + Standing BP?
- DMII
- 80 or over
- Postural HypoT symptoms
Outline the 3 stages of HyperT
Stage 1;
- Clinic BP: 140/90 or over
- ABPM/ HBPM: 135/85 or over
Stage 2;
- Clinic: 160/ 100 or over
- ABPM/ HBPM: 150/95 or over
Stage 3;
- Systolic >179
- Diastolic >119
What is Accelerated/ Malignant HyperT?
- Severe BP increase to 180/120 or higher
- With signs of Retinal Haemorrhage/ Papilloedema
In Pregnancy, outline Hyper T, Severe HT and Chronic HT
BP tends to fall in Trimesters 1 +2
HyperT: Systolic 140-159, Diastolic 90-109
Severe HT: Systolic >159, Diastolic >109
Chronic HT: HT present at/ 20wks before gestation
What counts as significant proteinuria in pregnancy?
- PCR of 30/+
- ACR of 8/+
Compare Gestational HT, Pre-eclampsia and Eclampsia
Gestational HT: New HT after 20wks gestation without significant proteinuria
Pre-eclampsia: New HT after 20wks gestation with significant proteinuria
Eclampsia: Seizures in a woman with Pre-eclampsia
What primary prevention management do you give to someone at high risk of Pre-eclampsia
- Daily Aspirin 75-150mg from 12wks gestation until birth
- BP and dipstick urine at each visit
List Pre-eclampsia symptoms
- Severe headache (unrelieved by simple analgesia)
- Visual problems (Blurred, Flashing lights, Diplopia, Floating spots)
- Peristsent new Epigastric pain or RUQ pain
- Vomiting
- SoB
- Sudden swelling of hands/ face/ feet
