Chronic Kidney Disease

Question 1

What defines CKD?

Answer 1

reduction in kidney function or structural damage (or both) present for >3 months, with associated health implications

Question 2

List 6 unmodifiable risk factors for CKD

Answer 2

Age
Male
Black/ hispanic
FH
AI diseases e.g. SLE
Chronic NSAIDs use

Question 3

List 2 modifiable risk factors for CKD

Answer 3

Smoking.

Obesity

Question 4

List 3 conditions that are risk factors for CKD

Answer 4

Cardiovascular disease
SLE
Vasculitis

Question 5

List 5 common causes of CKD

Answer 5

Diabetic nephropathy
Chronic glomerulonephritis
Chronic pyelonephritis
HTN
Adult polycyctic kidney disease

Question 6

What is kidney function assessed on?

Answer 6

GFR + albumin:creatinine ratio (ACR)

Question 7

What formula is most commonly used to calculate eGFR? Which variables does this account for?

Answer 7

Modification of Diet in Renal Disease (MDRD) equation
Serum creatinine
Age
Gender
Ethnicity

Question 8

What is stage 1 CKD?

Answer 8

Kidney injury with normal or elevated GFR

eGFR >90

Question 9

What is stage 2 CKD?

Answer 9

Mild reduction in GFR

eGFR 60-89

Question 10

What is stage 3 CKD?

Answer 10

Moderate reduction in GFR
3a eGFR 45-59
3b eGFR 30-44

Question 11

What is stage 4 CKD?

Answer 11

Severe reduction in GFR

eGFR 15-29

Question 12

What is stage 5 CKD?

Answer 12

End-Stage Renal Failure

eGFR <15

Question 13

List 5 examples of evidence of chronic kidney damage

Answer 13

Persistent microalbuminuria.
Persistent proteinuria.
Persistent haematuria
Structural abnormalities of the kidneys eg, PKD, reflux nephropathy.
Biopsy: proven chronic glomerulonephritis.

Question 14

List 5 symptoms that may present in late-stage CKD

Answer 14

Fatigue
N+V
Pruritus
Anorexia
Restless legs

Question 15

What 4 signs of CKD may be found on examination?

Answer 15

Oedema: ankle swelling, weight gain
HTN
Peripheral neuropathy
Pallor

Question 16

Why are both serum urea and creatinine not good assessments of renal function?

Answer 16

Urea: varies with hydration + diet, is not produced constantly + is reabsorbed by the kidney.
Creatinine: can remain within the normal range despite loss of >50% of renal function.

Question 17

What is the gold standard assessment of renal function? What is used in practice?

Answer 17

Isotopic GFR (expensive + not widely available.)
eGFR used in primary care

Question 18

Which serum electrolytes are tested in CKD? What are the levels seen

Answer 18

Na: N/ L
K: HIGH
HCO3: LOW.
Ca: N, L or H
Phosphate HIGH

Question 19

What other biochemical markers are tested in suspected CKD? What may levels of these indicate?

Answer 19

Plasma glucose: identify/ assess diabetes
ALP: high when bone disease develops.
PTH: high with declining renal function.
Cholesterol + triglycerides: dyslipidaemia common.
Albumin: hypoalbuminaemia in nephrotic +/or malnourished

Question 20

What is the haematological picture in CKD?

Answer 20

Normochromic normocytic anaemia; Hb falls with progressive CKD.
White cells + platelets usually normal.

Question 21

What is checked for in serology in suspected CKD?

Answer 21

Autoantibodies: ANA (SLE), c-ANCA (granulomatosis with polyangiitis), Anti-GBM (Goodpasture’s syndrome)
Hepatitis serology
HIV serology

Question 22

What is checked for in urinalysis in CKD? Why?

Answer 22

Proteinuria + haematuria
Degree of proteinuria correlates with rate of progression of underlying kidney disease + is the most reliable prognostic factor in CKD.

Question 23

Why perform serum and urine protein electrophoresis in suspected CKD?

Answer 23

to screen for multiple myeloma.

Question 24

What imaging investigations may be performed in CKD? What can be detected in each?

Answer 24

US: small/ large kidneys, structural abnormalities
CT/MRI: renal stones/ renal artery stenosis
X-Ray: renal stones

Question 25

Describe 7 features in management of CKD

Answer 25

eGFR monitoring
BP control
Lifestyle: Exercise, Lose weight, Smoking cessation
Good glycaemic control in DM
Review all prescribed medication
Avoidance of nephrotoxins: eg, NSAIDs, aminoglycosides.
Immunise against influenza + pneumococcus.

Question 26

In decreasing order, what are the most common causes of CKD in the UK?

Answer 26

Diabetes 24%
Glomerulonephritis 13%
High BP/ renovascular disease 11%