Chronic Kidney Disease

Question 0

What does renal injury cause?

Answer 0

Renal injury causes renal tissue to be replaced by extracellular matrix in response to tissue damage

Question 1

What is chronic kidney failure?

Answer 1

Irreversible and sometimes progressive loss of renal function over a period of months to years.

Question 2

Aetiology of chronic kidney disease?

Answer 2

Immunologic eg glomerulonephritis
Infection eg polynephritis
Hypertension
Vascular eg cardiovascular disease
Systemic disease eg diabetes, myeloma
Neoplasm 
Hypercalcaemia

Question 3

Who is chronic kidney disease more common in?

Answer 3

Elderly
Ethnic minorities
Socially disadvantaged

Question 4

Risk factors for chronic kidney disease?

Answer 4

Acute insults from nephrotoxins
Decreased perfusion
Increased renal ammonia formation with interstitial injury
Hyperlipidaemia
Hyperphosphataemia with calcium phosphate deposition

Question 5

What are the GFR a categories?

Answer 5

G1-G5
G1 - GFR >90 - normal/high
G2 - GFR 60-89 - mildly decreased
G5 - GFR < 15 - kidney failure

Question 6

What are the ACR categories for classification of kidney disease?

Answer 6

ACR = albumin:creatinine ratio 
A1 = 30 severely increased

Question 7

What do most patients die of before needing dialysis?

Answer 7

Cardiovascular disease

Question 8

What is end stage renal failure? (ESRF)

Answer 8

When kidney disease reaches a stage when death is imminent without renal replacement therapy

Question 9

What cardiovascular problems can chronic kidney disease (CKD) cause?

Answer 9

Atherosclerosis
Cardiomyopathy
Pericarditis

Question 10

How can CKD a affect haematology?

Answer 10

Can cause anaemia due to decreased levels of or resistance to erythropoietin

Question 11

How does renal bone disease happen?

Answer 11

Decreased GFR

• less phosphate excreted
• increased phosphate serum concentration
• forms complexes with calcium
• reduces calcium effective serum conc
• stimulates parathyroid to produce PTH
• overactivity of osteoclasts
• osteitis fibrosa cystica

Question 12

How can damage to kidneys cause osteomalacia and hyperparathyroidism?

Answer 12

Less vitamin D undergoes second hydroxylation to its active form
Causes hyoerparathyroidim and osteomalacia

Question 13

What CNS problems can CKD cause?

Answer 13

Neuropathy
Seizures
Coma

Question 14

What general symptoms can CKD cause?

Answer 14

Tiredness
Breathlessness
Restless legs
Sleep reversal
Seizure
Aches and pains
Nausea and vomiting 
Itching
Chest pain

Question 15

Investigations for CKD to measure renal function?

Answer 15

GFR - renal function expressed as a percentage of the normal range
GFR can be measured by inulin clearance or 24hr creatinine clearance

Question 16

What needs to be done if creatinine is used as a GFR a marker?

Answer 16

Needs to be modified by an equation to predict estimated GFR a
Equation takes into account age, gender and ethnicity

Question 17

Phagocytosis investigations are used to assess the cause of CKD?

Answer 17

Auto-antibody screen
Immunoglobulin
CRP
Complement
ANCA
SPEP/UPEP
Imaging of kidneys
-ultrasound for size and hydronephrosis
-CT
-MRI

Question 18

Management of CKD?

Answer 18

Lifestyle - smoking, obesity, exercise
Treat any diabetes
Treat blood pressure
ACE inhibitors/angiotensin receptor blockers
Lipid lowerers (statins/diet)
All to slow progression 

Patient should be monitored by checking eGFR and indications for initiation of dialysis

Question 19

What GFR a value indicates need for renal replacement therapy?

Answer 19

eGFR < 15ml/min

Question 20

What does renal replacement therapy include?

Answer 20

Dialysis

Transplant

Question 21

Indications for dialysis?

Answer 21

eGFR<15 ml/min
Uraemia symptoms
Acidosis
Pericarditis
Fluid overload
Hyperkalaemia

Question 22

How is peritoneal dialysis done?

Answer 22

Peritoneal dialysis fluid is put into the peritoneal cavity and the dialysis occurs across the peritoneal membrane. Fluid is then drained away and disposed of.

Question 23

Advantages of peritoneal dialysis?

Answer 23

Low technology
Home technique
Easily learnt
Allows mobility
CVS stability
May be better for elderly and diabetics

Question 24

Disadvantages of peritoneal dialysis?

Answer 24

Frequent exchanges (~4/day)
No long term survivors
Frequent treat failures
Peritonitis
Limited dialysis dose range
High revenues costs

Question 25

What are the sources for kidneys for renal transplant?

Answer 25

Cadaver donors
Non-heartbeating donors
Living related/friend donors
Autristic donors

Question 26

Where is the transplanted kidney put?

Why?

Answer 26

Iliac fossa

Can easily be connected to iliac vessels and bladder

Question 27

Advantages of renal transplant?

Answer 27

Restores near normal renal function
Allows mobility and rehabilitation 
Improved survival 
Good long term results 
Cheaper than dialysis

Question 28

Disadvantages of renal transplant?

Answer 28

Not all are suitable
Limited donor supply
Operative morbidity and mortality
Life-long immunosuppression 
Still left with progressive CKD

Question 29

Symptoms of end-stage renal disease?

Answer 29

Tiredness - overwhelming fatigue, physically and mentally incapacitated
Difficulty sleeping
Lack of concentration
Symptoms and signs of volume overload (SoB, oedema)
Pruritis
Sexual dysfunction and reduced fertility
Increased infections

Question 30

Complications of CKD?

Answer 30

Acid-base balance disturbance
Anaemia
Accumulation of waste products
Altered drug metabolism

Question 31

How is acid-base disturbance managed? Why do CKD patients get it?

Answer 31

Acidosis can be worsened by bone disease and can require NaHCO3
Stop ACE inhibitors

Question 32

Why do patients with CKD get anaemia?

Answer 32

• lack of erythropoeitin
• shortened red blood cell survival
• increased tendancy to bleed (reduced platelet function)
• contributes to tiredness and reduction in exercise tolerance

Question 33

What are uraemia symptoms caused by and give some examples

Answer 33

Accumulation of waste products

Reduced appetite
Nausea and vomiting
Pruritis