Chronic kidney disease

Question 1

What are some common causes of chronic kidney disease

Answer 1

diabetic nephropathy
chronic glomerulonephritis
chronic pyelonephritis
hypertension
adult polycystic kidney disease- most common genetic causes

Question 2

What is usually seen on history and examination of someone with CKD

Answer 2

USUALLY ASYMPTOMATIC

late stage features -

oedema
polyuria
lethargy
pruritus
anorexia
insomnia
nausea and vomiting
hypertension

Question 3

What investigations are required for CKD

Answer 3

eGFR
proteinuria - ACR
haematuria - dipstick/microscopy
renal ultrasound

Question 4

What other investigations are required to identify risk factors

Answer 4

blood pressure - for hypertension

HbA1c- for diabetes

lipid profile - for hypercholesterolaemia

Question 5

How do you classify chronic kidney disease

Answer 5

Diagnosis can be made when there are consistent results over 3 months of either

• eGFR below 60ml/min/1.73mm squared

-Urine albumin:creatinine ratio is above 3mg/mmol

Question 6

What is the G staging for CKD

Answer 6

G stage based on eGFR

G1- over 90
G2- 60-89
G3a-45-59
G3b-30-44
G4-15-29
G5-under 15

Question 7

What is the A staging for CKD based on?

Answer 7

Albumin:creatinine ratio

A1- under 3 mg/mmol
A2-3-30mg/mmol
A3- above 30 mg/mmol

Question 8

What are some complications of CKD

Answer 8

anaemia
renal bone disease
CVD
peripheral neuropathy
end- stage kidney disease
dialysis-related complication

Question 9

What things require referral to a renal specialist based on NICE guidelines

Answer 9

eGFR less than 30ml/min/1.73m squared

Urine ACR >70

Accelerated progression - decrease in eGFR of 25% within 12 months

5 year risk of requiring dialysis over 5%

uncontrolled hypertension despite 4 or more anti-hypertensives

Question 10

What does treating the underlying cause for CKD involve

Answer 10

-optimising diabetic control

-optimising hypertension control

-reducing/avoiding nephrotoxic drugs

• treating glomerulonephritis

Question 11

What is the blood pressure target in patients under 80 with CKD and an ACR >70

Answer 11

130/80

Question 12

What is used to manage metabolic acidosis

Answer 12

oral sodium bicarbonate

Question 13

What is used to treat anemia

Answer 13

Iron and EPO

iron deficiency needs to be corrected before starting erythropoiesis-stimulating agents

hence ferrous sulphate needs to be given first

Question 14

what is used to treat renal bone disease

Answer 14

Vitamin D, low phosphate diet and phosphate binders

Question 15

What does management of end-stage renal disease involve

Answer 15

special dietary advice
dialysis
renal transplant

Question 16

When giving ACEI to patients what electrolyte needs monitoring

Answer 16

serum potassium needs close monitoring as both CKD and ACEI can cause hyperkalemia

Question 17

What is the screening test for adult polycystic kidney disease

Answer 17

Ultrasound

Question 18

What effect does tolvaptan have in CKD drug therapy

Answer 18

it has been shown to reduce the rate of CKD progression in Adult polycystic kidney disease

so given to patients who have CKD stage 2 or 3 and is rapidly progressive .

Question 19

What types of renal replacement therapy is available to patients.

Answer 19

haemodialysis
peritoneal dialysis
renal transplant

Question 20

What is haemodialysis

Answer 20

most common form
regular filtration of blood through a dialysis machine in hospital
3 times per week
arteriovenous fistula created which is site for haemodialysis

can also be performed at home

Question 21

What is peritoneal dialysis

Answer 21

Filtration occurs within patients abdomen
dialysis solution injected into abdominal cavity through a catheter

dialysis solution is drained, removing waste products and then exchanged for a new dialysis solution

Question 22

What are the 2 types of peritoneal dialysis

Answer 22

continuous ambulatory peritoneal dialysis -patient can undergo normal activities with dialysis solution inside abdomen

automated peritoneal dialysis - dialysis machine fills and drains abdomen while patient is sleeping

Question 23

What is renal transplantation

Answer 23

receipt of kidney from either live or deceased donor
failing kidneys remain in abdomen
patient will then need life long immunosuppressants

Question 24

What are some complications associated with haemodialysis

Answer 24

site infection
endocarditis
stenosis at site
hypotension
cardiac arrhythmia
air embolism
anaphylactic reaction
disequilibration syndrome- caused by cerebral oedema - rare but serious complication

Question 25

What are some complications associated with peritoneal dialysis

Answer 25

peritonitis
catheter infection
catheter blockage
constipation
fluid retention
hernias
back pain

Question 26

What are some complications associated with renal transplantation

Answer 26

DVT/PE
opportunistic infection
malignancies
bone marrow suppression
Urinary tract obstruction
CVD

Question 27

What is the most common cause of peritonitis secondary to to peritoneal dialysis

Answer 27

coagulase-negative staphylococcus species