chronic kidney disease

Question 1

what is chronic kidney disease defined as

Answer 1

reduction in kidney function
or
structural damage 
or
both

and
present for more than 3 months
with
associated health implications

Question 2

what are the markers of kidney damage

Answer 2

THE ASS

Transplant - anyone with a history of kidney transplant
Histological abnormalities detected on kidney biopsy
Electrolyte abnormalities due to tubular disorders

ACR greater than 3mg/mmol
Sediment abnormalities in the urine (haematuria/casts)
Structural abnormalities detected by imagine

and/or
a persistent reduction in renal function show by a serum eGFR of less than 60ml/min/1.73msquared

Question 3

stages of CKD

Answer 3

Question 4

what defines accelerated progression of CKD

Answer 4

Question 5

causes of CKD

Answer 5

• diabetes
• high blood pressure
• glomerular disease
• polycystic kidney disease

Question 6

what drugs could cause CKD

Answer 6

• aminoglycosides
• ACE inhibitors
• ARAs
• bisphosphonates
• calcineurin inhibitors
• diuretics
• lithium
• mesalazine
• NSAIDs

Question 7

causes of obstructive uropathy

Answer 7

• calculi
• prostate (malignancy, BPH, prostatitis, abscess)
• bladder disease
• malignancy of urothelial tract
• strictures/stenosis
• extrinsic compression (lymph nodes etc)

Question 8

what are some multisystem diseases that can cause CKD

Answer 8

• SLE
• vasculitis
• myeloma

Question 9

what are some hereditary kidney diseases that cause CKD

Answer 9

• autosomal dominant polycystic kidney disease
• alport syndrome
• familial glomerulonephritis

Question 10

complications of CKD

Answer 10

• cardiovascular disease
• acute kidney injury
• hypertension
• dyslipidaemia
• renal anaemia
• renal mineral and bone disorder

Question 11

what causes renal mineral and bone disorder

Answer 11

caused by disturbed vit D, calcium, PTH and phosphate metabolism due to impaired regulation of intestinal absorption, renal tubular excretion and vitamin D activation

Question 12

symptoms of renal mineral and bone disorder

Answer 12

• bone pain
• increased bone fragility
• extra skeletal calcification

Question 13

risk modification for CKD

Answer 13

• treat underlying cause
• smoking cessation
• weight loss
• aerobic exercise
• limiting salt intake
• control of hypertension
• lipid lowering therapy
• consider aspirin for secondary prevention

Question 14

blood pressure aim for people with hypertension and CKD

Answer 14

systolic - below 140

diastolic - below 90

Question 15

aim for bp in people with CKD, diabetes and hypertension (and ACR of 70mg/mmol or more

Answer 15

systolic - below 130

diastolic - below 80

Question 16

when do you not modify the dose of ACEis and ARBs

Answer 16

if either

eGFR decrease from pre-treatment baseline is less than 25%

or

the serum creatinine increase from baseline is less than 30%

Question 17

what is the lipid lowering therapy in CKD

Answer 17

• offer atorvastatin 20mg for prevention of CVD

- increase dose if a greater than 40% reduction in non-HDL cholesterol is not achieved and eGFR is 30 or more

Question 18

treatment for mineral bone disorder

Answer 18

• dietary advice
• phosphate restriction
• vitamin D (alfacalcidol)
• non-calcium based phosphate binders (lanthanum/sevelamer)

Question 19

target Hb for renal anaemia

Answer 19

100-120g/L