Chronic Kidney Disease

Question 1

How do you measure excretory renal function?

Answer 1

• Insulin clearance
• Isotope GFR
• 24 hour urine collection plus blood test
• GFR estimating equations (most commonly used in clinical practice)
  
  • Creatinine

Question 2

What is a problem with using creatinine to estimate GFR?

Answer 2

A problem with using creatinine is it is generated from the breakdown of muscle, and not everyone has the same muscle mass, it also depends on:

• Age
• Ethnicity
• Gender
• Weight
• Other issues such as liver disease

Question 3

What are some different formulae used to estimate GFR from serum creatinine?

Answer 3

Question 4

What is used to stage kidney disease?

Answer 4

International chronic kidney disease (CKD) classification

Question 5

What is chronic kidney disease (CKD)?

Answer 5

Defined by either presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR <60ml/min/1.73m² that is present for 3 or more months

Question 6

What are the different categories of albuminuria?

Answer 6

A1

A2

A3

Question 7

What is the prevalence of chronic kidney disease (CKD)?

Answer 7

About 8-12% in UK

Increases with age

Question 8

What is the aetiology of CKD?

Answer 8

• Polycystic kidney disease
• Diabetes
• Glomerulonephritis
  
  • And all the causes of that
• Hypertension
• Renovascular disease

Question 9

What is the clinical presentation of CKD?

Answer 9

Question 10

What are important parts of the history for CKD?

Answer 10

• Previous evidence of renal disease
• Family history
• Systemic diseases
• Drug exposure
• Pre/post renal factors
• Uraemic symptoms

Question 11

What are important parts of the examination for CKD?

Answer 11

• Vital signs
• Volume status
• Systemic illness
• Obstruction

Question 12

What investigations are done for chronic kidney disease (CKD)?

Answer 12

• Blood tests
  
  • U and Es, FBC
• Urine tests
  
  • Urine dip, urine PCR or ACR (24-hour collection)
• Histology
  
  • Renal biopsy
• Radiology

Question 13

What investigations can be done to detect the aetiology of CKD?

Answer 13

• Chemistry
  
  • Urea, creatinine, electrolytes (Na, K, Cl)
  • Bicarbonate
  • Total protein, albumin
  • Calcium, phosphate
  • Liver function tests
  • Creatine kinase
  • Immunoglobulins, serum protein electrophoresis
• Haematology
  
  • Full blood count
    
    • Hb
    • MCV
    • MCH
    • WBC
    • Platelets
    • % of hypochromic RBCs
  • Coagulation screen
    
    • PT
    • APPT
    • With or without fibrinogen
• Urine investigations
  
  • Urinalysis (“dipstick”
    
    • Blood
    • Protein
  • Protein quantification
    
    • Protein creatinine ratio (PCR)
    • Albumin creatinine ratio
    • 24 hour urine collection
• Imaging
  
  • US
    
    • Advantages
      
      • Non-invasive
      • No ionising radiation
      • May provide information about chronicity of renal disease
    • Disadvantages
      
      • No functional data
      • Operator dependant
• Pathology
  
  • Kidney biopsy

Question 14

What are some complications related to reduced GFR?

Answer 14

• Acidosis
• Anaemia
• Bone disease
• CV risk
• Death and dialysis
• Electrolytes
• Fluid overload
• Gout
• Hypertension
• Iatrogenic issues