Chronic Kidney Disease

Question 1

What is the definition of CKD?

Answer 1

Impaired renal function >3months based on abnormal structure or function; eGFR<60

Question 2

What value must the eGFR be lower than?

Answer 2

60

Question 3

What are the causes of CKD? (7)

Answer 3

1. Diabetes 2. Glomerulonephritis 3. 20% unknown 4. Hypertension/venovascular disease 5. Pyelonephritis 6. Reflux Nephropathy 7. Inherited causes e.g Adult Polycystic Kidney disease

Question 4

What is stage 1?

Answer 4

eGFR >90

Question 5

What is stage 2?

Answer 5

Mild, eGFR 60-89

Question 6

What is stage 3?

Answer 6

Moderate, eGFR 30-59

Question 7

What is stage 4?

Answer 7

Severe, eGFR 15-29

Question 8

What is stage 5?

Answer 8

End failure, eGFR <15

Question 9

What are some other signs that provide evidence of CKD? (3)

Answer 9

Persistent microalbuminaemia, Proteinuria, Haematuria

Question 10

Is CKD common?

Answer 10

Common but frequently unrecognised!

Question 11

Who does it affect?

Answer 11

Generally older people and those with diabetes, stages 3-5 are more common in females

Question 12

Risk factors (8)

Answer 12

Cardiovascular disease, Diabetes, AKI, Hypertension, Smoking, African or Asian, Chronic NSAID use, untreated urinary tract obstruction

Question 13

Symptoms (12)

Answer 13

Anorexia, vomiting, restless legs, fatigue, weakness, pruritis, bone pain, amenorrhoea, impotence, oliguria, dyspnoea, ankle swelling

Question 14

Signs (9)

Answer 14

Pallor, yellow skin (uraemia), purpura, excoriations (from prutitis), hypertension, cardiomegaly, ballotable cystic kidneys, arrhythmias, seizures

Question 15

Differential? (1)

Answer 15

AKI

Question 16

What bloods would you do? (8)

Answer 16

FBC, U&E, Creatinine, eGFR, Glucose, Calcium (low), Phosphate (high), LFTs

Question 17

Other investigations (10)

Answer 17

Urinalysis, 24 hour urine collection for Creatinine clearance, ECG, Renal tract imaging, Ultrasound, Abdominal Xray, IV Pyelogram, CT, MRI, Renal Biopsy

Question 18

Treatment (4)

Answer 18

Identify and treat reversible causes, limit progression or complications e.g Reduce blood pressure, treat bone disease with calcium and vitamin D, statins, Aspirin, Low protein and low potassium diet; Symptom control e.g Iron, B12 and folate for anaemia, Bicarbonate supplements for acidosis, diuretics for oedema; Renal replacement therapy e.g Haemodialysis, haemofiltration, Peritoneal Dialysis

Question 19

Complications (6)

Answer 19

Anaemia (low EPO), Coagulopathy, Hypertension, Calcium Phosphate Loading, Renal Osteodystrophy, Secondary Hypoparathyroidism

Question 20

Is there a good prognosis?

Answer 20

Early diagnosis prevents progression, moderate/severe CKD increases risks of AKI, Falls, Frailty and mortality