10.5 Key Concepts in Chronic Kidney Disease (CKD)

Question 1

Is CKD a disease?

Answer 1

No. it is a state, a syndrome, just like AKI/ARF

Question 2

What is the diagnostic criteria for CKD/the minimum timeframe?

Answer 2

• GFR less than 60 for >= 3 months
  OR:
• Signs of kidney disease (albuminuria, haematuria of no other cause, pathological abnormalities) for >=3 months

Question 3

It is estimated that __% of people with CKD know they have it

Answer 3

10% (!!!!)

Question 4

List, from more to less common, some causes of CKD

Answer 4

• Diabetes
• Glomerulonpehritis (2° to IgA nephropathy, nephrotic syndrome, lupus etc.)
• Hypertension
• Polycystic kidney disease
• Cancer

Question 5

What are some common presenting symptoms of CKD? What is an important qualifier to this?

Answer 5

• Common symptoms include nausea/vomiting (metabolic imbalance), oedema (low albumin), itchy skin (uraemia), SOB (acidosis + hypoalbuminuria), changes to urination
• However, we are thought to be able to lose up to 90% kidney function without experiencing symptoms, so patients may be asymptomatic

Question 6

Predialysis, non-lifestyle treatment methods for CKD are…

Answer 6

• BP control (reduce damage)
• Reduce proteinuria
• Smoking cessation (reduce damage)
• Correct acidosis (symptomatic relief)
• Glycaemic control (prevent damage/UTI, which would worsen it)
• Treat any complications of kidney failure (symptomatic relief)

Question 7

Lifestyle modifications for CKD include…

Answer 7

• Dietary sodium restriction (prevent fluid retention)
• Weight reduction
• Smoking cessation
• Avoid over the counter NSAIDs

Question 8

What therapies might we consider in end-stage renal disease?

Answer 8

• Transplantation (preferred for QOL)
• Dialysis

Question 9

Explain, in terms of calcium and phosphate, how CKD affects the bones, and what the consequence of this is called

Answer 9

• Decreased GFR means phosphate is retained in blood
• High phosphate suppresses vit D3 production
• This causes less calcium to be absorbed, thus weakening the bones
• This is called osteodystrophy

Question 10

List 6 clinical consequences of CKD

Answer 10

• Anaemia (decreased EPO, uraemia kills RBCs faster)
• Hypertension ()dec perfusion compensation by JGA)
• Chronic uraemia (decreased GFR)
• Metabolic acidosis (decreased acid clearance)
• Hyperkalaemia (decreased potassium clearance
• Osteodystrophy (high phosate [dec GFR] suppresses Vit D3)

Question 11

What are some clinical consequences of hyperkalaemia?

Answer 11

• Arrythmias (disrupted cardiomyocyte resting membrane potential)
• Muscle weakness (lowered membrane potential)
• Neurologic signs such as confusion (altered neuron membrane potential)

Question 12

Differences between CKD and ARF/AKI

Answer 12

• AKI is more likely reversible
• AKI treatment is to reverse cause and support kidneys, CKD treatment is to slow damage as much as possible

Question 13

What are the broad principles of management of CKD?

Answer 13

• Manage hypertension
• Manage anaemia (such as recombinant EPO)
• Improve hypocalcaemia and hyperphosphataemia
• Dietary restrictions (decreased sodium, weight loss etc.)
• Consider transplant/dialysis in end-stage patients

Question 14

What pathologic changes can chronic hypertension creates in the kidneys? What is this called, as a unified disease process?

Answer 14

• Ateries: arteriosclerosis, wall thickeining, lumen narrowing, smc hyperplasia
• Glomerulus: glomerulosclerosis
• Tubulointerstitial: interstitial fibrosis

(Collectively, this is called benign nephrosclerosis)

Question 15

What pathologic changes can malignant hypertension creates in the kidneys? What is this called, as a unified disease process?

Answer 15

• Arteries: acute necorsis due to extreme endothelial damage, “onion skinning” concentric, latered thickening of the arterioles, narrowed lumen & dec perfusion
• Glomerulus: necrosis, microthrombi formation, ischaemic glomerulosclerosis
• Tubules: acute tubular necrosis

(Collectively, this can be referred to as malignant nephrosclerosis)