Chronic Kidney Disease

Question 1

What is chronic kidney disease?

Answer 1

Longstanding, progressive impairment in renal function

Persistent (more than 3 months) evidence of kidney damage AND/OR impaired GFR

Question 2

What are the requirements for a diagnosis of CKD?

Answer 2

Persistent (more than 3 months) evidence of kidney damage

AND/OR

Impaired GFR

Question 3

What are the stages of CKD?

Answer 3

Stage 1: GFR > 90

Stage 2: GFR 60-89

Stage 3: GFR 30-59

Stage 4: GFR 15-29

Stage 5: GFR

Question 4

All stages of CKD are a concern.

True or false?

Answer 4

False, only need to start being concerned at stages 3 onwards

Stage 1 + 2 are pretty normal

Question 5

What are the causes of CKD?

Answer 5

Diabetes, especially type II

Glomerulonephritis

Hypertension

Renovascular disease: atherosclerosis

Pyelonephritis

Polycystic Kidney Disease

Permanent damage following AKI

Urinary tract obstruction

Question 6

What are the clinical features of CKD?

Answer 6

Early stages are usually asymptomatic

Bilaterally small kidneys on USS

Renal signs:

• haematuria
• proteinuria
• uraemia
• raised creatinine

Systemic manifestations

Question 7

Why does CKD cause anaemia?

Answer 7

Kidney is damaged

So less production of erythropoietin

Less stimulation of bone marrow to produce RBCs

Fewer RBCs, so anaemia

Question 8

What is erythropoietin and what does it do?

Answer 8

It is a hormone that stimulates the bone marrow to produce more RBCs

Question 9

Why does CKD cause cardiovascular symptoms?

Answer 9

Because CKD causes hypertension

Hypertension causes CVS problems, like stroke, MI

Also CKD causes cardiomyopathy, problems with cardiac muscle

Question 10

What systemic manifestations occur in CKD?

Answer 10

Anaemia
Renal osteodystrophy
Cardiovascular problems
Neurological problems

Oedema: pulmonary + peripheral

Question 11

What is renal osteodystrophy?

Answer 11

Bone disease that occurs when the kidneys fail to maintain healthy levels of calcium and phosphorus in the blood

Osteomalacia
Osteoporosis

Question 12

Investigations of CKD?

Answer 12

Blood tests

Urinalysis

USS: kidneys are small, could also show causes of CKD

Question 13

What blood tests would you do to investigate CKD?

Answer 13

FBC: signs of anaemia

ESR: inflammatory cause

U+E: raised urea + creatinine, decreased calcium

Glucose: check for diabetes

Question 14

What urine tests would you do to investigate CKD?

Answer 14

Look for haematuria + proteinuria

Casts: suggestive of glomerulonephritis

White cells: infection

Question 15

How do you calculate eGFR?

Answer 15

Using serum creatinine levels

Question 16

What are the 4 stages of management of CKD?

Answer 16

1. Treating reversible causes
2. Limiting progression + complications
3. Symptom control
4. Consideration of renal replacement therapy

Question 17

What are some examples of reversible causes of CKD?

Answer 17

Obstruction can be removed

Nephrotoxic drugs can be stopped

Blood glucose can be controlled

Question 18

What should you do to limit progression of CKD?

Answer 18

Control BP: ACEi

Diuretics: control hyperkalaemia and oedema

Lifestyle modifications: diet, weight, exercise

Question 19

How can you limit the progression of renal osteodystrophy?

Answer 19

Phosphate levels are raised in CKD and this causes damage

Reduce phosphate levels: binders, reduce dietary intake

Question 20

How can you limit the progression of cardiovascular problems caused by CKD?

Answer 20

Statins to reduce cholesterol
Aspirin
Medication to reduce BP

Question 21

How can you manage acidosis caused by CKD?

Answer 21

Sodium bicarbonate supplements

Improves symptoms and slows progression