8.16 Chronic Kidney Disease

Question 1

Define Chronic kidney disease

Answer 1

• kidney damage or ⬇️ kidney function
• GFR <60ml/min
• for >= 3 months

Markers of kidney damage:
- proteinuria
- active urine sediment
- abnorm blood chemistry
- imaging

Question 2

NB Classification of CKD

Answer 2

STAGE GFR Decription
1; 90+; norm kidney function, genetic trait of kidney disease
2; 60-89; mild rediced kidney func + other findings
3A; 45-59; moderately reduced kidney func
3B; 30-44; moderately reduced kidney func
4; 15-29; severe ⬇️ kidney func
5; <15 or dialysis; ENDSTAGE

Question 3

Causes

Answer 3

• hypertention
• diabetes
• CIN
• obstruction
• unknown

Question 4

Pathophysiology of Chronic Kidney Disease

Answer 4

Initiating factors (causes) ➡️ ⬇️ number of nephrons ➡️ vasoactive mediators, cyokines, RAS, growth factors ➡️ structural and functional changes of surviving nephrons ➡️ Hyperfiltration ➡️ ⬆️interglomerular pressure ➡️ accelerated sclerosis of remaining nephrons

Question 5

Consequences / adaptations of Chronic Kidney failure

Answer 5

Metabolic
- Fluid
- Electrolytes/Acid-basis abnormalities

Uraemia
- Urea non-toxic
- Accumulation of toxins

Endocrine
- Anaemia
- CKD-MBD

Question 6

Management

Answer 6

• control BP
• weight reduction
• stop smoking
• phosphate binders
• correct anaemia
• ⬇️ cholestrol
• dietary protein restriction

Question 7

How do you retard the disease?

Answer 7

Use ACEI / ARBS

Question 8

What is the main cause of death in many of these pt?

Answer 8

Cardiovascular disease