Chronic Kidney disease

Question 1

What is the reference range for creatinine?

Answer 1

50-110 μmol/L

Question 2

What is the ddx of a creatinine of 150umol/ml in an otherwise asypmtomatic person?

Answer 2

Lots of muscle bulk, chronic renal failure.

Question 3

Is high creatinine itself dangerous?

Answer 3

No- High urea or electrolyte imbalances are worrying.

Question 4

What is the bone disease associated with kidney disease

Answer 4

Renal osteodystrophy

Question 5

What is the significance of an eGFR of 45 in a 73 year old?

Answer 5

• In healthy adults eGFR falls by up to 10 mL/min/1.73m2 per decade beyond the age of 40 – BUT reduced eGFR is associated with cardiovascular risk for all ages • In people aged >70 years, stable eGFR values between 45 and 59 mL/min/1.73m2 may be consistent with normal GFR for this age, if no other signs of kidney damage (e.g. proteinuria, haematuria) are present.

Question 6

What is the definition of chronic kidney disease (CKD)?

Answer 6

eGFR 3 months: • microalbuminuria • proteinuria • glomerular haematuria • pathological abnormalities (eg. on renal biopsy) • anatomical abnormalities (eg. cysts on ultrasound) 

Question 7

At what GFR may symptoms start to be a problem and dialysis may be considered?

Answer 7

eGFR= 15

Question 8

At what GFR is dialysis necessary regardless of symptoms?

Answer 8

eGFR=5

Question 9

How is proteinuria defined?

Answer 9

>3g protein in 24hour urine collection or protein/creatinine ration >45mg/mmol or albumin/creatinine ratio >30mg/mmol

Question 10

What is normal urinary protein excretion?

Answer 10

<200mg/day

Question 11

How is proteinuria defined?

Answer 11

Proteinuria is defined as a protein/creatinine ratio greater than 45 mg/mmol (which is equivalent to albumin/creatinine ratio of greater than 30 mg/mmol or approximately 300 mg/g) with very high levels of proteinuria having a ratio greater than 100 mg/mmol.

Question 12

What are some states which can cause proteinuria not due to CKD (6)?

Answer 12

UTI, sepsis, CCF, strenuous exercise, heavy protein intake, menses

Question 13

What are the 3 tests you can do on urine to assess kidney function?

Answer 13

dipstick MC/S ACR/PCR/ 24 hour urine protein

Question 14

What are 5 principles of management of all CKD patients?

Answer 14

• Diagnosing the cause of CKD - Managing the increased CV risk (bp, lipids, glucose control) - Managing metabolic abnormalities (eg high phosphate, low calcium, high K) and endocrine side effects (low EPO) - Preventing disease progression (BP, lipids, glucose control) - Titrating drug dosing

Question 15

equal serum creatinine in a female and male- is the eGFR the same in both?

Answer 15

No- eGFR will be lower in the female (less muscle mass so would expect a lower serum creatinine)

Question 16

How does a healthy kidney look on US?

Answer 16

Kidney should be hypoechoic compared to the liver. If it is more echogenic this indicates damage to the kidney.

Question 17

How do unhealthy kidneys look on US?

Answer 17

small and echogenic

Question 18

Where do the antibodies deposit in IgA nephropathy?

Answer 18

Mesangium

Question 19

What are the two most important modifiable risk factors for the progression of CKD?

Answer 19

• Hypertension and proteinuria are the two most important modifiable risk factors for reducing progression of CKD

Question 20

What is the target BP for a patient with CKD? What is the target BP for a patient with CKD and diabetes/ proteinuria?

Answer 20

– <130/80 mm Hg
– <125/75 mm Hg in proteinuria/Diabete

Question 21

What is the leading cause of death in CKD patients?

Answer 21

Cardiovascular disease

Question 22

What are the outcomes of a chronic metabolic acidosis?

Answer 22

• Muscle catabolism - Metabolic bone disease - Reduced immune function

Question 23

What are the symptoms of symptomatic chronic renal failure?

Answer 23

General Lethargy & malaise Fluid overload Nocturia Cardiovascular High blood pressure Heart failure Pericarditis IHD Gastrointestinal Anorexia Nausea/vomiting Dysgeusia/metallic taste in mouth Skin Pruritis Neurological Peripheral neuropathy Seizures Restless legs Ophthalmologic Changes of HT may be present