Chronic Kidney Disease

Question 1

Key symptoms / signs in CKD

11 key areas

Answer 1

• HTN –> can lead to HF
• Increased urea –> Gout, ‘uremic frost’, uremic encephalopathy, pericarditis, lethargy, contributes to met. acidosis
• Hyperkalaemia –> Cardiac arrhythmias (esp if exacerbated by acidosis)
• Decreased erythropoietin synthesis –> anaemia
• Fluid overload –> HTN, Odema, Pulmonary Oedema
• Hyperphosphataemia –> Direct result on vascular calcification, thus CV risk
• Hypocalcaemia –> Secondary hyperparathyroidism
• Metabolic acidosis –> reduced excretion of sulphates
• Iron deficiency anaemia
• Accellerated atherosclerosis
• Sexual dysfunction

Question 2

Key causes of CKD

Answer 2

• DM –> most cases
• Idiopathic
• Congenital: Polycystic Kidney Disease
• Pre-renal: Bilateral renal artery atherosclerosis, vasculitis of small renal vessels
• Glomerulonephritis: esp. focal segmental glomerulosclerosis, membranous glomerulonephritis, IgA nephropathy
• Tubulointerstitial: Largely drug-reation-induced
• Obstructive: Renal stones, malignancies downstream, urinary retention, etc.

Question 3

Stages of CKD based on GFR

Answer 3

Stage 1:    90+
Stage 2:    60-89
Stage 3:    30-59
Stage 4:    15-29
Stage 5:

Question 4

Broad aims of treatment in CKD

Answer 4

1. Treat any underlying cause that may be reversed / stopped

2. Manage CVD risk factors

Question 5

Outline medical treatment in Stage 1-4 CKD

Answer 5

• ACEIs / ARBs (shown to reduce progression to end-stage) (control of HTN)
• Management of CV risks
• – Statins –> lipid lowering
• – Lifestyle
• – Optimal DM management of BSLs, HbA1c

Other things to consider:

• Erythropoietin replacement
• Calcitrol replacement
• Iron (esp before erythropoietin replacement)
• Phosphate binders to control hyperphosphatemia

Question 6

Treatment options in Stage 5 CKD

Answer 6

• Dialysis

- Ideally renal transplant

Question 7

Biggest killer in CKD

Answer 7

CVD