Chronic Kidney Disease

Question 1

Define chronic kidney disease

Answer 1

Abnormalities in kidney structure or function for more than 3 months with implications to health.

Implications to health is indicated by the following:

eGFR < 60 or markers of kidney damage such as proteinuria, albuminuria, urine sediment abnormalities (e.g. haematuria), el;ectrolyte abnormalities due to tubular disorders.

Question 2

What are some of the markers of kidney damage?

Answer 2

Proteinuria

Albuminuria

Haematuria

Electrolyte abnormalities (due to tubular disorders)

Question 3

Chronic kidney disease is interchangeable with which other terminology?

Answer 3

Chronic renal failure

Question 4

What are the two most common causes of CKD?

Answer 4

Diabetes (most)

Hypertension

Question 5

What GFR indicates kidney failure?

Answer 5

GFR < 15

Question 6

What is a typical presentation of chronic kidney disease?

Answer 6

Tend to mostly be asymptomatic until later stages

Question 7

What are the two main laboratory findings suggestive of CKD?

Answer 7

Reduced GFR

Elevated serum creatinine

Question 8

List the main risk factors for CKD (9)

Answer 8

• Diabetes
• Hypertension
• Age >50
• Male sex
• Black or Hispanic ethnicity
• Long-term analgesic use
• Obesity
• Smoking
• Family history
• History of childhood renal disease (e.g. pyelonephritis)
• Pmx of systemic diseases such as SLE or gout

Question 9

What are the main signs/symptoms of CKD? (7)

Answer 9

Presence of risk factors

Fatigue (due to uremia or anemia)

Oedema (salt and water retention alongside hypoalbuminaemia)

Nausea with or without vomitting (Accumulation of toxic waste)

Pruritis (toxic waste buildup under the skin)

Restless legs (symptom of uraeamia)

Anorexia (toxic waste)

Question 10

Suggest 2 reasons why some patients with CKD present with fatigue

Answer 10

Due to aneamia (Kidney cant produce erythropoietin needed for RBC formation)

Ureamia

Question 11

Why can kidney disease result in anaemia?

Answer 11

Kidneys are needed to produce erythropoietin which is required for RBC formation so if the kidneys are damaged this will affect production.

Question 12

Give an example of a toxic waste that accumulates in the body due to kidney dysfunction.

Answer 12

Urea

Question 13

List 4 symptoms that present in kidney disease due to buildup of urea and other toxic wastes in the body

Answer 13

Pruritis

Nausea with or without vomitting

Anorexia

Restless legs

Question 14

What investigations should be ordered in patients suspected of CKD? (5)

Answer 14

Renal chemistry/Renal function tests (U&Es and bicarbonate ect)

Serum creatinine to calculate eGFR

Urinalysis (to look for mainly haematuria [proteinuria mya be seen but must do urine ACR to confrim])

Urine ACR (to look for proteinuria)

Renal ultrasound: Only if criterion are met

Question 15

What investigation findings may be seen in patients with CKD

Answer 15

RFTs: Elevated serum creatinine, electrolyte abnormalties

Urinalysis: Protienuria and haematuria

eGFR: Less than 60

urine ACR: Increased ACR [Albumin to creatinine] ratio suggesting albuminuria

Question 16

What criteria of CKD patients are indicated for renal ultrasound? (6)

Answer 16

CKD patients with any of the following:

Accelerated progression of CKD
Have visible haematuria or persistent microscopic haematuria
Family history of polycystic kidney disease
Have symptoms of urinary obstruction
Have eGFR less than 30
Are in need of a renal biopsy by a nephrologist

Question 17

Frequency of monitoring for CKD patients depends on which factors?

Answer 17

Severity of eGFR

Severity of ACR

Question 18

What lifestyle changes should be encouraged in patients diagnosed with chronic kidney disease?

Answer 18

Exercise

Dietary changes (cut on salt, pottasium, phosphate and calories) [DO NOT encourage a low protein diet].

Smoking cessation

Question 19

What is the management plan for patients with CKD?

Answer 19

Offer an ACE or ARB in patients with CKD and hypertension with an ACR > 30

Offer ACE or ARB in diabetics with a ACR >3 regardless of if hypertensive or not.

Give statin to all patients (E.g., atorvastatin)

For ACR <70: BP should be lower than 140/90 (target range:120-139)

For ACR >70: BP should be lower than 130/80 (target range 120-129)

CONSIDER offering anticoagulant for secondary cardioprotective effects but beware of increased risk of bleeding.

Question 20

What is the management plan for a patient with severe CKD/Kidney failure (eGFR < 15) with uraemia? (4)

Answer 20

Renal dialysis

2nd line: Kidney transplant

Dietary modification

Phosphate binding drugs

Question 21

Other causes of anemia should be considered in which type of CKD patients?

Answer 21

If eGFR