Chronic Kidney Disease

Question 1

What is chronic kidney disease?

Answer 1

• impaired renal function for more than 3 months
  OR
• GFR < 60 mL/ min/ 1.73m2 for more than 3 months

Question 2

What is the GFR for stage 4 CKD?

Answer 2

GFR < 30

Question 3

What is the GFR for end stage renal failure?

Answer 3

GFR < 15

Question 4

When are symptoms of CKD usually seen

Answer 4

symptoms are usually seen in later stage of CKD - stage 4 when GFR < 30.

Question 5

What are the causes of CKD?

Answer 5

-Diabetes
- Glomerulonephritis
- unknown (20%)
- Hypertension / renovascular disease
- Pyelonephritis and reflux nephropathy
- chronic interstitial nephritis ( amyloid)
- adult polycystic kidney disease
-

Question 6

Which high risk patients should be screened so that CKD can be intervened before progression to end stage renal failure?

Answer 6

• diabetic
• hypertensive
• Cardiovascular disease ( IHD, periferal vascular D, cerbrovascular D)
• Structural renal disease ( stones, BPH)
• Recurrent UTIs / childhood reflux
• autoimmune conditions e.g SLE
• family history of end stage renal disease

Question 7

What are the symptoms can be experienced in CKD?

Answer 7

Uraemic symptoms:

• anorexia
• vomiting
• restless legs
• fatigue
• weakness
• pruritis (itch)
• bone pain
• amenorrhoea
• impotence

Question 8

What examination signs are seen in CKD?

Answer 8

• pallor
• uraemic (yellow) tinge to skin
• purpura
• excoriations (scratch marks)
• raised BP
• cardiomegaly
• fluid overload
• irregular pulse, encephalopathy (due to hyperK+)

Question 9

What Inv should be done for CKD?

Answer 9

1) Blood
FBC ( Hb - anaemia)
ESR / CRP
U&E (GFR, creatinine, urea - AKI on CKD?)
glucose (diabetes)

2) Urine:
Dipstick (+ve nitrites, +ve leuc, + heam - glomerulonephritis? inf?)
MSU - red cell? inf?
albumin
creatinine:protein ration

3) Imaging:
- USS (smaller kidney)

4) Histology :
renal biopsy if rapidly progressive disease.

Question 10

How is CKD managed?

Answer 10

1) identify and treat reversible cause e.g obstruction, stop nephrotoxic drugs,
2) maintain constant BP (ACEi or ARB)
3) Treat renal bone disease by monitoring and lowering PTH if raised. (phosphate rises in CKD —> rise in PTH —> bone disease), give vit D and calcium supplements.
4) Cardiovascular - statins if raised lipids, asprin,
5) Diet - moderate protein intake, K+ restriction if hyperK+, avoid high phosphate food.

Question 11

How are the symptoms of CKD treated?

Answer 11

• Anaemia (replace iron, B12, folate if necessary)
• Acidosis (sodium bicarbonate supplements)
• Oedema (high dose diuretics)
• Restless legs / cramps (low levels of ferritin worsen symptoms, give gabapentin or clonazepam), Quinine sulfate for cramps.
• renal replacement therapy.