Chronic Kidney Disease

Question 1

What is it

Answer 1

Reduced GFR and/or evidence of kidney damage over a long period of time

Question 2

How is GFR assessed

Answer 2

24-hour urine collection measuring creatinine clearance

Question 3

Stage 1 disease

Answer 3

GFR >90 with evidence of kidney damage

Question 4

Stage 2 disease

Answer 4

GFR 60-90 with evidence of kidney damage

Question 5

Stage 3 disease

Answer 5

GFR 30-60

Question 6

Stage 4 disease

Answer 6

GFR 15-30

Question 7

Stage 5 disease

Answer 7

GFR <15

Question 8

Causes of chronic kidney disease

Answer 8

Diabetes 
Hypertension
Chronic GN
Polycystic kidney disease
NSAIDS, ciclosporin, lithium

Question 9

By what stage of disease do symptoms usually occur

Answer 9

Stage 4

Question 10

Symptoms

Answer 10

Fatigue 
Anorexia
Itch 
Sleep disturbance
Nocturia
Oliguria

Question 11

what calcium disorder does CKD cause

Answer 11

Secondary hyperparathyroidism

Question 12

Biochemistry of secondary hyperparathyroidism

Answer 12

Low calcium, High PTH, High Phosphate

Question 13

Why is there reduced calcium absorption in CKD

Answer 13

Vitamin D is hydroxylated in the kidney- this is impaired in CKD so calcium cannot be absorbed

Question 14

why is anaemia a complication of CKD

Answer 14

Erythropoetin is produced by the kidneys- loss causes anaemia

Question 15

Treatment

Answer 15

Lifestyle change (limit alcohol)
ACEi
Statins (decrease CV risk)
Dialysis at end stage

Question 16

Symptoms of anaemia

Answer 16

Tiredness
Breathlessness
Palpitations

Question 17

Treatment of anaemia due to CKD

Answer 17

IV iron or

Weekly injections of erythropoietin + iron (second line)

Question 18

Management of bone disease

Answer 18

Alfacalcidiol 
Phosphate binders (calcium carbonate)

Question 19

Most common acute complication of haemodialysis

Answer 19

Hypotension

Question 20

Causative organism of peritonitis in peritoneal dialysis

Answer 20

Staph epidermidis