Chronic Kidney Disease

Question 1

MRD4 calculates the GFR for which people?

Answer 1

White/asian men

-correction factor for women and for black race

Question 2

GFR and muscle mass

Answer 2

Overestimates GFR if muscle mass is low

Underestimates GFR if muscle mass is high

Question 3

Stage 1 CKD

Answer 3

GFR >90ml/min, with evidence of kidney damage

Question 4

Stage 2 CKD

Answer 4

GFR 60-90ml/min, with evidence of kidney damage

Question 5

Stage 3 CKD

Answer 5

GFR 30-60
(3A: 45-60
3B: 30-44)

Question 6

Stage 4 CKD

Answer 6

GFR 15-30

Question 7

Stage 5 CKD

Answer 7

GFR <15 or on renal replacement therapy

Question 8

CKD and cardiovascular risk

Answer 8

CKD increases cardiovascular risk

Question 9

Proteinuria and CKD

Answer 9

Patients with proteinuria more likely to progress (and get worse kidney failure etc)

Younger patients have longer to progress and are more likely to reach stage 5

Question 10

GFR at which symptoms occur.

Answer 10

Occur late (GFR<20ml/min)

Question 11

Symptoms of chronic kidney disease?

Answer 11

Non-specific – tiredness, poor appetite, itch, sleep disturbance
Impaired urinary concentrating ability – symptoms may occur earlier - nocturia

Question 12

Drugs which reduce BP and proteinuria?

Answer 12

ACE inhibitors and ARBs
-also evidence for spironolactone

-CAUTION: initial fall in GFR (then gets better), hyperkalemia

Question 13

How do you reduce cardiovascular risk in CKD?

Answer 13

BP and proteinuria
Stop smoking
Statins

(good glycemic control)

Question 14

Why do you get anaemia in CKD?

Answer 14

Erythropoietin produced by the kidneys
Production declines in CKD
May be other causes for anaemia
Check iron status; if deficient, may need further investigation
Also check for vitamin B12 and folate deficiency

Question 15

You should check which vitamin levels in CKD?

Answer 15

Check vitamin B12 and folate deficiency

Question 16

Which organ hydroxylates vitamin D?

Answer 16

Kidneys
-this is impaired in CKD

-Leads to reduced calcium absorption, leading to secondary hyperparathyroidism
In advanced CKD, serum phosphate rises – also increases PTH secretion

Question 17

Why does serum phosphate rise in advanced CKD?

Answer 17

Kidneys cannot hydroxylate vitamin D

This leads to calcium absorption

This leads to secondary hyperparathyroidism

Phosphate also rises and this increased PTH secretion further

Question 18

Consequences of high calcium and high phosphate?

Answer 18

Leads to vascular calcification

• this makes calcified vessels stiff
• HEART VALVES also calcified!

Question 19

Drug you can give for CKD bone disease?

Answer 19

Alfacalcidol (hydroxylated vitamin D)

Question 20

What is alfacalcidol?

Answer 20

Hydroxylated vitamin D

Question 21

Name some phosphate binders

Answer 21

Calcium carbonate
Calcium acetate
Sevelamer

Question 22

What are calcium carbonate, calcium acetate and sevelamer?

Answer 22

Phosphate binders

Question 23

What GFR would you start dialysis?

Answer 23

Around 20ml/min (earlier if progressing fast)

Question 24

If you give a fistula, what GFR would you refer patient to vascular surgeon?

Answer 24

Refer at about 15ml/min

Question 25

When can someone be listed for transplantation?

Answer 25

When within 6 months of dialysis

Question 26

How do you correct anaemia?

Answer 26

Correct deficiencies, usually IV iron
-If still anaemic, give erythropoietin (Epo) (by injection, week or fortnight
Target Hb – 10.5-12.5g/dl
As Epo works, iron stores depleted – need regular top-ups)

Question 27

If IV iron fails to correct anaemia, what can you give?

Answer 27

If still anaemic – erythropoietin (Epo) may be indicated
Epo – by injection; every week or fortnight
Target Hb – 10.5-12.5g/dl
As Epo works, iron stores depleted – need regular top-ups

Question 28

Target Hb?

Answer 28

10.5-12.5 g/dl