Chronic Kidney Disease

Question 1

what is CKD

Answer 1

reduction in kidney function or structure or both present for >3months

Question 2

stages of CKD

Answer 2

GFR- G1-G5, ACR- A1-A3

G5= GFR <15
ACR: A1= <3, A3= >30

Question 3

what is accelerated progression CKD

Answer 3

persistent dec in eGFR of 25% and change in CKD category within 12 months

Question 4

aetiology of CKD

Answer 4

intrinsic kidney damage- HT, DM
AKI bouts 
nephrotoxic drugs
obstructive uropathy: calculi 
multisystem: SLE, vasculitis 
CVD
obesity

Question 5

some nephrotoxic drugs?

Answer 5

amionglycosides, ACEI/ARBs, bisphosphonates, calcineurin inhibitors, diuretics, lithium, mesalazine, NSAIDs

Question 6

s/s of chronic renal disease

Answer 6

thirst, loss of interest in food, vitamin imbalance, malnutrition, anaemia

Question 7

ix for CKD

Answer 7

urinary albumin: Cr ratio
urinary sediment abnormalities 
electrolyte imbalance 
histology 
imaging

Question 8

mx for CKD

Answer 8

lifestyle: fluid restirocton, K+ restriction

RRT: ESRD

treat underlying condition

Question 9

what are 2 complications of CKD

Answer 9

renal anaemia: due to reduced production of erythropoietin by kidney, diabetes inc risk, tiredness, fatigue. mx- iron supplements

renal mineral and bone disorder: bone pain/fragility due to disturbed VitD, Ca, PTH and phosphate metabolism

Question 10

glomerulonephritis is…

Answer 10

immune mediated disease of the kidneys affecting glomeruli with 2y tubulointerstitial damage. chronic Gn is most common cause of ESRD

Question 11

what are the 2 histologic types of Gn

Answer 11

damage to endothelial or mesangial cells- proliferative lesion- RBCs in urine

damage to podocytes- non-proliferative lesion- protein in urine

Question 12

what does it mean if lesion is crescentic

Answer 12

presence of crescents ie. epithelial cell extra-capillary proliferation

Question 13

types of Gn

Answer 13

1y idiopathic:

• minimal change
• FSGS
• Membranous
• Membranoproliferative
• IgA nephropathy

2y

Question 14

minmal change Gn…

Answer 14

commonest Gn in kids, non progressive renal failure

oral steroids

Question 15

FSGS Gn..

Answer 15

commonest cause of nephrotic syndrome in adults, oral steroids (50% progress to ESRF after 10yrs)

Question 16

membranous…

Answer 16

2nd most common cause of nephrotic syndrome in adults
1y or 2y (hep B, SLE, malignancies)
mx: steroids, B-cell monoclonal ABs
30% progress to ESRF

Question 17

IgA nephropathy…

Answer 17

commonest Gn in the world, HSP, colitis, arthritis association
asymptomatic
renal biopsy: mesangial cell proliferation and IgA deposits in mesangium on light microscopy
mx: BP control/ACEi, 25% progress to ESRF

Question 18

2y causes of Gn

Answer 18

infection, malignancy, systemic- ANCA vasculitides, lupus, good pasture’s, HSP

Question 19

ix for Gn

Answer 19

bloods, urine (urinalysis- haematuria, proteinuria, urine microscopy (RBC, granular casts, lipiduria), urine protein: cR ratio))
kidney biopsy
light microscopy/ IF/ EM used for classifying

Question 20

s/s of Gn

Answer 20

include haematuria, proteinuria, impaired renal function, hypertension, nephrotic/ nephritic syndrome

Question 21

tx for Gn

Answer 21

non-IS: statins, ACEI/ARBs, diuretics

immunosuppression: corticosteroids, azathioprine, calcineurin inhibitors (cyclosporin)

Question 22

what is rapidly progressive GN

Answer 22

rapid deterioration in renal function in days/weeks

Question 23

aetiology of RPGN

Answer 23

vasculitis, ANCA +ve- GPA, ANCA -ve- goodpasture’s, HSP, SLE

Question 24

ix for RPGN

Answer 24

urinary sedament (RBCs, granular casts), crescents present on biopsy

Question 25

mx for RPGN

Answer 25

immunosuppression- azathioprine

plasmapheresis