Chronic Kidney Disease*

Question 1

What is CKD

Answer 1

eGFR is lower than 60ml/min/1.73m2 for >3 months

Normal =120

Question 2

How can CKD be classified by eGFR

Answer 2

1 = 90+ w/ renal Sx
2= 60-90 w renal Sx
3a = 45-60
3b = 30-45
4 = 15-30
5 = <15

Question 3

What are the 4 parameters used to stage CKD

Answer 3

CAGE
-Creatinie
-Age
-Gender
-Ethnicity

Question 4

What are the best readings used to quantify CKD

Answer 4

eGFR

ACR (albumin-creatinine ratio)

Question 5

What are the RF of CKD

Answer 5

DM
HTN
GN
PKD
NSAIDs

Question 6

Which diabteic drug is CI in CKD

Answer 6

Metformin when eGFR <30
-Below stage 4

Question 7

What is the pathology of CKD

Answer 7

Damaged nephrons decrease GFR
Increased Burden on working nephrons
Compensatory RAAS - increase GFR and Increase transglomerular pressure
Increase sheering and loss of selecetive permeability
Proteinuria and haematuria
Mesangial scarring (Angiotensin 2 activates TGF-B and Plasminogen activator-inactivator)

Question 8

What mechanism in CKD causes increased GFR but also Increased Transglomerular pressure

Answer 8

Compensatory RAAS

Question 9

What is the result of increased Transglomerular pressure

Answer 9

Sheering and loss of Basement membrane selective permeability = heamaturiea and preoteinurea

Question 10

What is activated to cause Mesnagial scarring

Answer 10

TGF-B and Plasminogen activ/inactivator

Question 11

Why do most patients present aymptomatic w/ CKD

Answer 11

Compensatory effect of working nephrons

Question 12

What are the presentations of CKD

Answer 12

early = ASx

substance accumulation and renal damage (Diabetic nephropathy)

Question 13

What are the complications of CKD (CCANOU)

Answer 13

CCANOU

• CVD
• Contrast induced AKI
• Anaemia (Low EPO)
• Neuropathy
• Osteodystrophy (low Vit D)
• Urea = protein/haem

Question 14

In Anaemia 2nd to CKD, what causes it

Answer 14

Low EPO

Question 15

How is CKD investigated

Answer 15

FBC (Anaemia of chronic)
U+E
Urine Dipstick (proteinurea)
USS (Bilateral small kidneys)
GFR function staging
ACR >3 shows proteinuria

Question 16

CKD has no cure but how can its complications be managed

Answer 16

Anaemia? Fe + EPO
Osteodystrophy? Vit D
CVD? ACE and statins (Decrease HTN)
Oedema? Diuretics
Kidney transplant

Question 17

At what stage should there be an RRT referral

Answer 17

Stage 5

-<15

Question 18

What is difference in what you look at between AKI and CKD

Answer 18

AKI = serum creatine/ urea and urine output
CKD = eGFR and ACR

Question 19

Do both AKI and CKD present w/anaemia

Answer 19

Only CKD (Anaemia of chronic)

Question 20

What does USS show on CKD vs AKI

Answer 20

AKI = normal
CKD = Bilateral small kidneys

Question 21

Describe the process of mesangial scarring

Answer 21

Angiotensin 2 increases TGF-B and plasminogen activator 1

Question 22

How can contrast induced AKI be treated

Answer 22

IV Saline 0.9% before and after use

Question 23

Are there any early presentations of CKD

Answer 23

NO asymptomatic

Question 24

What is the normal eGFR Value

Answer 24

120

Question 25

What drug is contraindicated in AKI but used for CKD Management

Answer 25

ACE inhibitors