chronic kidney disease

Question 1

What is the GFR

Answer 1

Glomerular filtration rate - the rate of filtrate coming from the glomerulus to bowman’s capsule

Question 2

What is the effect of higher pressure on the GFR

Answer 2

higher pressure causes an increased GFR

Question 3

How do you measure excretory renal function

Answer 3

Measure substances that are only cleared by the kidney - e.g creatinine

Question 4

At what GFR does plasma creatinine begin to increase

Answer 4

As GFR drops below 50%

Question 5

What factors affect the serum creatinine

Answer 5

Age
ethnicity - African Americans have a higher serum creatinine due to higher muscle mass
gender
weight
other illnesses
muscle mass
Diet

Question 6

How is creatinine generated

Answer 6

The breakdown of muscle

Question 7

How do we classify excretory function using eGFR

Answer 7

International Chronic kidney disease classification system

Question 8

Describe the eGFR and give a description for stage 1 on the International Chronic kidney disease classification system

Answer 8

Kidney damage /normal or high GFR - GFR is greater than 90

Question 9

Describe the eGFR and give a description for stage 2 on the International Chronic kidney disease classification system

Answer 9

Kidney damage / mild decrease in GFR - GFR is between 60-89

Question 10

Describe the eGFR and give a description for stage 3a and 3b on the International Chronic kidney disease classification system

Answer 10

3a - moderately impaired - GFR 45-59

3b - moderately impaired - GFR 30-44

Question 11

Describe the eGFR and give a description for stage 4 on the International Chronic kidney disease classification system

Answer 11

Severely impaired - GFR 15-29

Question 12

Describe the eGFR and give a description for stage 5 on the International Chronic kidney disease classification system

Answer 12

Advanced or on dialysis - GFR is less than 15

Question 13

How is the filtering function of the kidney assessed

Answer 13

Checking if the glomerular basement membrane is letting larger substances through - e.g Red blood cells, albumin and other high molecular weight proteins

Checking glucose as it should be reabsorbed and not excreted

It is checked by urinalysis (dipstick)
or protein quantification (Protein creatinine ratio)

Question 14

What can cross the glomerular basement membrane

Answer 14

electrolytes and creatinine

Question 15

What can’t cross the glomerular basement membrane

Answer 15

Red blood cells and white blood cells
High molecular weight proteins like albumin and globulins

Question 16

What can cross the glomerular basement membrane but should be reabsorbed in the proximal tubule

Answer 16

glucose

Question 17

What are issues in the glomerular basement membrane usually called

Answer 17

Glomerular nephritis

Question 18

Define chronic kidney disease

Answer 18

A GFR of less than 60 or the presence of kidney damage that is present for more than or equal to 3 months

The kidney damage can be found by - abnormal blood, urine or x-ray findings

Question 19

What is the relationship between CKD and age

Answer 19

A s age increases, risk of CKD increases

Question 20

What is the most potent detector of end stage kidney disease

Answer 20

Proteinuria

Question 21

What is renal replacement therapy

Answer 21

Dialysis or kidney transplant

Question 22

What are the most common causes of chronic kidney disease

Answer 22

Diabetes
Glomerulonephritis
Systemic disease
Reno-vascular disease
Genetic disorders like polycystic kidney disease

Question 23

What tests are done to find the cause of a patients chronic kidney disease

Answer 23

Blood tests - U&E and a full blood count
Urine tests - dipstick and protein creatinine ration
Histology and radiology

Question 24

What imaging is used in finding the cause of CKD

Answer 24

Ultrasound - it is non invasive with no radiation and can show how large the kidney is - small kidneys indicate chronic kidney disease

Question 25

Why is kidney biopsy only done sometimes

Answer 25

It can only be used when it is safe to do so and can not be used when there is a high risk of bleeding

Question 26

What is the most important thing to control in slowing the rate of renal decline

Answer 26

Blood pressure

Question 27

Why does chronic kidney disease cause uncontrolled blood pressure

Answer 27

It causes a loss of control of the renin-angiotensin-aldosterone system

Question 28

What can be given to control proteinuria

Answer 28

ACEi - e.g ramipril - end in pril

ARBs - e.g candesartan - end in sartan

SGLT2 inhibitors - empagliflozin - end in flozin

Treating underlying cause

Question 29

Why can ACE inhibitors(ACEi) angiotensin receptor blockers (ARBs) control proteinuria

Answer 29

They inhibit angiotensin II and therefore relax the afferent arteriole and constrict the efferent arteriole which causes relaxation of the glomerulus

Question 30

When are ACEi and ARBs not indicated in kidney disease

Answer 30

with acute because they cause constriction of the efferent arteriole which means there is bad outflow as well as the inflow

Question 31

What are the implications of SGLT2 inhibitors

Answer 31

Can cause UTI, can make diabetic foot disease worse and can cause euglycaemic ketoacidosis

Question 32

At what time can you go on the renal transplant list

Answer 32

When you are less than 6 months away from needing renal replacement therapy