Chronic Kidney disease

Question 1

what is the definition of CKD?

Answer 1

Reduced GFR and/or evidence of kidney damage

cannot be established from 1 measurement

Question 2

Measurement of kidney function?

-downfalls

Answer 2

serum creatinine/protein ratio

-overestimates GFR in low muscle mass
underestimates in high muscle mass
only if serum creatinine stable

Question 3

Patients more likely to progress to later stage CKD?

Answer 3

those with proteinuria

younger patients have longer to progress

Question 4

Define the stages of CKD (1-5)

Answer 4

Stage 1 – GFR >90ml/min, with evidence of kidney damage
Stage 2 – GFR 60-90ml/min, with evidence of kidney damage
Stage 3 – GFR 30-60ml/min
(3A – 45-60ml/min; 3B – 30-44ml/min)
Stage 4 – GFR 15-30ml/min
Stage 5 – GFR

Question 5

Common causes of CKD (6)

Answer 5

Diabetes (affects small vessels)
Hypertension (renal artery stenosis)
Vascular disease
Chronic glomerulonephritis
Reflux nephropathy
Polycystic kidneys

Question 6

When doe symptoms of reduced GFR present?

-symptoms (4)

Answer 6

GFR

Question 7

How do we slow progression of CKD?

• monitering?
• how reduce CV risk?

Answer 7

reduce proteinuria
control BP
(via ACE inhibitors and ARBs, also spironolactolone)
good blood glucose control
smoking cessation

• bloods for hyperkalaemia
• Statins + ^^

Question 8

complications of CKD

Answer 8

Anaemia
Bone disease
Hyperparathyroidism

Question 9

Anaemia in CKD

• why?
• management?

Answer 9

-due to reduced erythropoietin production in the kidneys
OR iron status, Vit B12, folate deficiency

-IV iron, erythropoietin injections
target Hb 105-125 g/l

Question 10

Bone disease in CKD

• Why?
• biochem in advanced CKD
• Why does the ^^ occur
• complication of bone disease,
• management

Answer 10

Vit D hydroxylated in the Kidney and impaired in CKD, leads to reduced Ca absorption and secondary hyperparathyroidism

-serum phosphate rises, increased PTH secretion

-normal serum Ca maintained at the expense of the bones so get hyperplasia of all glands
one gland may become autonomous and no longer suppressed by Ca and then get tertiary hyperparathyroidism

• vascular calcification, also heart valves,
• give alfacalcidol and phosphate binders

Question 11

4 treatment options for end stage renal failure?

• when does prep occur?
• best form of access?

Answer 11

Haemodialysis
Peritoneal dialysis
Transplantation
Conservative management

• GFR 20ml/min
• Arteriovenous fistula