Chronic Kidney Disease

Question 1

Define Chronic Kidney Disease

Answer 1

Abnormalities of kidney structure of function, present for >3 months, with kidney damage or GFR < 60mL/min/1.73m2

Question 2

Aetiology of Chronic Kidney Disease

Answer 2

Diabetes Mellitus and Hypertension are the most common causes

Vascular: HTN, renal artery atheroma, vasculitis
Glomerular: Glomerulonephritis, diabetes, amyloid, SLE
Tubulointerstitial: Pyelonephritis/interstitial nephritis, nephrocalcinosis, TB
Obstruction and others: Myeloma, HIV nephropathy, scleroderma, gout, renal tumour, inborn errors of metabolism e.g. Fabry’s disease
Congenital/inherited: Polycystic kidney disease, Alport’s syndrome, congenital hyperplasia

Question 3

Symptoms of Chronic Kidney Disease

Answer 3

Fatigue 
Nausea with/without vomiting
Pruritus 
Anaemia: Dyspnoea
Restless legs
Anorexia
Arthralgia 
Foamy, cola-coloured urine 
Rashes
Orthopnoea
Seizures

Question 4

Signs of Chronic Kidney Disease on examination

Answer 4

Enlarged prostate gland
Retinopathy
Oedema
Signs of anaemia (due to erythropoietin deficiency)

Question 5

Investigations for chronic kidney disease

Answer 5

Renal Chemistry: elevated Cr and serum abnormalities
eGFR: <60 mL/minute/1.73m2

Urinalysis: haematuria ± proteinuria
Urinary albumin: moderate increased

FBC: normochromic, normocytic anaemia
U+Es: reduced calcium
ALP, phosphate, PTH: raised

USS kidneys: small kidneys, presence of obstruction, hydronephrosis, stones
CXR: ?pericardial effusion, pulmonary oedema
Renal biopsy: changes specific to the underlying disease

Question 6

What drugs are associated with CKD

Answer 6

NSAIDs
Bisphosphonates
Antiplatelets
Anticoagulants/NOACs
Antibiotics e.g. gentamicin
Radiocontrast dye