Chronic Kidney Disease

Question 1

Definition of chronic kidney disease

Answer 1

The presence of kidney damage (abnormal blood, urine or x-ray findings) OR GFR <60 ml/min/1.73m2
FOR ≥3 MONTHS

Question 2

What is used to assess for kidney disease

Answer 2

Anatomy
Filtering function
Excretory function

Question 3

How is Excretory function assessed

Answer 3

GFR

Question 4

Formula used to estimate GFR from serum, creatinine

Answer 4

Cockcroft Gault

Question 5

What 4 substances are filtered out at the glomerulus

Answer 5

Water
Urea
Creatinine
Electrolytes

Question 6

What does not get filtered at the glomerulus

Answer 6

WBC
RFC
Large proteins like albumin

Question 7

How is kidney filtering assesed

Answer 7

Urinalysis (dipsticks)

Should be no blood or protein

Question 8

How is the anatomy of ghetto kidney assesed

Answer 8

Histology

Radiology

Question 9

Complications of CKD

AABCDDEF

Answer 9

Acidosis
Anaemia
Bone disease
Cardiovascular (Hypertension/arrhythmias)
Death & Dialysis
Electrolytes
Fluid overload

Question 10

7 causes of CKD

Answer 10

Heart Failure (persistently low kidney perfusion)
Hypertention 
Diabetes 
Sarcoidoses 
Polycystic kidney disease 
Nephrotoxic drugs 
Glomerulonephritis

Question 11

Tests for underlying aetiology of CKD

Answer 11

Blood tests- U&E’s, FBC
Histology - Biopsy
Urine test - Urinalysis (Dipstick)
Radiology- Ultrasound, CT, Plain Film

Question 12

4 steps in the clinical approach to CKD

Answer 12

1. Detection of the underlying aetiology (then treatment of it)
2. Slowing the rate of renal decline
3. Assessment of complications related to reduced GFR (prevention and treatment of those)
4. Preparation for Renal Replacement Therapy

Question 13

How to slow the rate of renal decline

Answer 13

BP management
Control Proteinuria
Control Acidosis
Dietary Protein Restriction

Question 14

CKD’s effect on activated vitamin D

Answer 14

Reduced levels as it’s activated in the kidney by 1 aplha-hydroxylase, which is low in CKD 》low activated vitamin D

Question 15

How does CKD lead to low calcium

Answer 15

Low vitamin D 》low Ca2+ intestinal reabsorption and reduced tubular reabsorption

Question 16

Why can CKD cause secondary hyperparathyroidism

Answer 16

Low vitamin D 》Ca2+ 》Increased PTH release

Question 17

Why can CKD cause bone disease

Answer 17

Low vitamin D 》Ca2+ 》Increased PTH release 》Increased activity of Osteoclasts》Increased calcium (released from bone weakening it)

Question 18

Management of CKD bone disease

Answer 18

Consume more Ca2+

Calcitriol (Active Vitamin D Analogue)

Question 19

Management of Acidosis and Anaemia caused by CKD

Answer 19

Acidosis - Bicarbonate

Anaemia - Erythropoietin (EPO) and Iron

Question 20

Management of CV risk and Death and Dialysis caused by CKD

Answer 20

CV risk - Aspirin, BP weight and cholesterol control, exercise
Death and Dialysis - Counsel and Prepare

Question 21

Management of Electrolytes and Fluid Overload

Answer 21

Electrolytes - Diet, consider drugs

Fluid Overload - Salt and Fluid restriction and diuretics

Question 22

What would suggest a poor prognosis

Answer 22

Low GFR and more proteinuria

Question 23

3 Common CKD complications

Answer 23

Anaemia
Acidosis
Bone disease