chronic kidney disease

Question 1

what is it?

Answer 1

CKD is defined by KDIGO as abnormal kidney function or structure for over 3 months, with implications for health.

A GFR below 60 ml/min/1.73m2 is considered significantly abnormal kidney function.

Question 2

what are RF for CKD?

Answer 2

Family history of CKD
Black or Hispanic ethnicity
History of acute kidney injury (AKI)
Older age

Question 3

what causes intrinsic kidney damage?

Answer 3

Diabetes
Hypertension
Glomerulonephritis, which may be primary or secondary
Conditions causing urinary tract obstruction:
Recurrent urolithiasis
Structural abnormalities (e.g. ureteropelvic junction obstruction)
External compression (e.g. from a pelvic mass)
Bladder voiding problems (e.g. benign prostatic hyperplasia, neurogenic bladder)

Question 4

what are iatrogenic causes of kidney damage?

Answer 4

Radiotherapy
Nephrotoxic drugs, e.g. aminoglycosides, lithium, NSAIDs

Question 5

what results in renal involvement secondary to multisystem diseases?

Answer 5

HIV
Myeloma
Vasculitis
Systemic lupus erythematosus (lupus nephritis)
Amyloidosis
Genetic kidney diseases
Autosomal dominant polycystic kidney disease (ADPKD)
Alport’s syndrome
Tuberous sclerosis
Cystinosis
Recurrent urinary tract infections
Often secondary to vesico-ureteric reflux or other anatomical defects
Leads to chronic pyelonephritis which may lead to end-stage renal disease

Question 6

how is CKD classified?

Answer 6

based on their GFR and urinary albumin:creatinine ratio (ACR).

Question 7

what is CKD 1?

Answer 7

Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)

Question 8

what is CKD 2?

Answer 8

60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)

Question 9

what is CKD 3a?

Answer 9

45-59 ml/min, a moderate reduction in kidney function

Question 10

what is CKD 3b?

Answer 10

30-44 ml/min, a moderate reduction in kidney function

Question 11

what is CKD 4?

Answer 11

15-29 ml/min, a severe reduction in kidney function

Question 12

what is CKD 5?

Answer 12

Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed

Question 13

features?

Answer 13

oedema: e.g. ankle swelling, weight gain
polyuria
lethargy
pruritus (secondary to uraemia)
anorexia, which may result in weight loss
insomnia
nausea and vomiting
hypertension