Chronic kidney disease

Question 1

Causes

Answer 1

Diabetes

HTN

Age-related decline

Glomerulonephritis

Chronic pyelonephritis

Polycystic kidney disease

Medications (NSAIDs. PPI, lithium)

Question 2

Risk factors

Answer 2

Older age

HTN

Diabetes

Smoking

Medications

Question 3

Presentation

Answer 3

Usually asymptomatic

Oedema

Polyuria

Lethargy

Pruritis (secondary to uraemia)

Anorexia

Insomnia

Nausea and vomiting

HTN

Muscle cramps

Question 4

Investigations

Answer 4

eGFR (2 tests required 3 months apart)

Proteinuria using urine albumin: creatinine ratio (>3mg/mmol is significant)

Haematuria using urine dip

Renal US

Question 5

Complications

Answer 5

Anaemia

Renal bone disease

CVD

Peripheral neuropathy

Dialysis related problems

Question 6

Anaemia causes

Answer 6

Reduced EPO levels (most significant factor) due to toxic effects if uraemia on bone marrow

Reduced absorption of iron

Anorexia/ nausea due to uraemia

Reduced red cell survival (especially in haemodialysis)

Blood loss due to capillary fragility and poor platelet function

Question 7

Management of anaemia

Answer 7

Target haemoglobin 10-12g/L

Many patients require IV iron

Erythropoiesis stimulating agents

Question 8

Bone disease

Answer 8

Low vit D, high phosphate, low calcium

Secondary hyperparathyroidism

hyperparathyroid bine disease
- reduction in cellular activity in bone
- osteomalacia
- osteosclerosis
- osteoporosis

Question 9

HTN treatment

Answer 9

ACEi first line

Furosemide

Question 10

Reducing risk of complications

Answer 10

Exercise, maintain a healthy weight and stop smoking

Special dietary advice about phosphate, sodium, potassium and water intake

Offer atorvastatin 20mg for primary prevention CVD

Question 11

Treating complications

Answer 11

Oral sodium bicarbonate to treat metabolic acidosis

Iron supplementation and EPO to treat anaemia

Vitamin D to treat renal bone disease

Dialysis in end stage renal disease

Renal transplant in end stage renal failure