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Chronic Kidney Disease (CKD)

Background Knowledge 🧠

Definition

  • Chronic kidney disease (CKD) is defined as persistent kidney damage or a glomerular filtration rate (GFR) <60 mL/min/1.73 mΒ² for over 3 months.
  • Progressive condition leading to decreased kidney function over time.

Epidemiology

  • Affects approximately 10-15% of the UK adult population.
  • Higher prevalence in older adults.
  • More common in individuals with diabetes, hypertension, and cardiovascular disease.
  • Increased incidence in certain ethnic groups (e.g., South Asian, African Caribbean).

Aetiology

  • Diabetic nephropathy.
  • Hypertensive nephrosclerosis.
  • Chronic glomerulonephritis.
  • Polycystic kidney disease.
  • Chronic interstitial nephritis.
  • Obstructive uropathy.

Clinical Features 🌑️

Symptoms

  • Often asymptomatic in early stages.
  • Fatigue and weakness.
  • Anorexia and weight loss.
  • Nausea and vomiting.
  • Pruritus.
  • Nocturia and polyuria.
  • Oedema.

Signs

  • Hypertension.
  • Oedema (peripheral, pulmonary).
  • Pallor.
  • Signs of underlying cause (e.g. diabetic retinopathy).
  • Pericardial friction rub (late-stage).

Investigations πŸ§ͺ

Investigations

  • Urinalysis: Proteinuria, haematuria.
  • Blood tests: Urea, electrolytes, creatinine, eGFR.
  • Nephritic screen.
  • Imaging: Renal ultrasound, MR renal angiogram if indicated.
  • Kidney biopsy if cause uncertain or rapidly progressing.
  • Albumin-creatinine ratio (ACR) or Protein-creatine ratio (PCR) for proteinuria assessment.

Management πŸ₯Ό

Management

  • Control underlying conditions (diabetes, hypertension).
  • Lifestyle modifications: Diet, exercise, smoking cessation.
  • Consider ACE-inhibitor, SGLT-2-inhibitor,Β and non-steroidal mineralocorticoid receptor antagonistΒ where indicated.
  • Regular monitoring of kidney function.
  • Dialysis or kidney transplantation in end-stage renal disease.
  • Patient education and support.

Complications

  • Cardiovascular disease.
  • Anaemia.
  • Bone disease (renal osteodystrophy).
  • Electrolyte imbalances (hyperkalaemia, metabolic acidosis).
  • Fluid overload.
  • Infections.
  • Uraemic complications (pericarditis, encephalopathy).

Prognosis

  • Progressive nature with risk of end-stage renal disease.
  • Prognosis varies with underlying cause and comorbidities.
  • Early detection and management can slow progression.
  • Regular follow-up is essential.

Key points

  • CKD is a common and serious condition.
  • Screen high-risk populations.
  • Manage underlying conditions and risk factors.
  • Regular monitoring and early intervention are crucial.
  • Multidisciplinary approach often required.

References

  • NICE Guidelines: Chronic Kidney Disease (https://www.nice.org.uk/guidance/ng203) NICE Guidelines

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