Chronic Kidney Disease

Question 1

What is the definition of CKD?

Answer 1

Defined by either the presence of kidney damage (abnormal blood, urine or x-ray findings)
OR GFR<60 ml/min/1.73m2 that is present for ≥3 months

Question 2

How do we estimate GFR?

Answer 2

Measure creatinine

Serum creatinine

Question 3

What causes variation in creatinine?

Answer 3

Muscle mass
Age
Ethnicity
Gender 
Weight

Question 4

What are accurate ways of measuring GFR?

Answer 4

Inulin

And isotop GFR

Question 5

Why do we not use inulin or isotope GFR in clinical practice?

Answer 5

Takes too long to clear

Question 6

What is GFR is CKD stage 1?

Answer 6

> 90

Question 7

What is GFR in CKD stage 2?

Answer 7

60-89

Question 8

What is GFR in CKD stage 3a?

Answer 8

45-59

Question 9

What is GFR in CKD stage 3b?

Answer 9

30-44

Question 10

What is GFR in CKD stage 4?

Answer 10

15-29

Question 11

What is GFR in stage 5 CKD?

Answer 11

<15

Question 12

What should urine dipsticks be used to test for?

Answer 12

Blood and protein

Question 13

Should there be blood and protein in the urine?

Answer 13

No

Question 14

What do the 3 classes of A1 A2 and A3 measure?

Answer 14

Albuminuria

Question 15

At what stage is CKD typically diagnosed at?

Answer 15

Stage 3

Question 16

As GFR decreases what is the risk of complication?

Answer 16

More likely to have complications

Question 17

What are some causes of CKD?

Answer 17

DM 
Glomerulonephritis
Hypertension
Renovascular disease
PKD
Chronic exposure to nephrotoxins
Chronic obstructive nephropathy

Question 18

What are some signs and symptoms of CKD?

Answer 18

Pallor
Hypertension 
SOB 
Proteinuria
Haematuria 
Peripheral oedema
Itch and cramps

Question 19

What blood tests should be done for CKD?

Answer 19

U&E
Creatinine 
Bicarbonate 
Total protein 
Toral albumin 
Calcium 
LFT 
Immunoglobulins 
Platelets 
Hb
Coagulation screen

Question 20

What urine tests should be done for CKD?

Answer 20

Blood
Protein
Protein creatinine ratio
Albumin creatinine ration

Question 21

What histology investigations should be done for CKD?

Answer 21

Renal biopsy

Question 22

What radiological investigations should be done for CKD?

Answer 22

USS
plain radiograph
CT
MRI

Question 23

What managing factors should be controlled in CKD?

Answer 23

BP control
Control proteinuria
Be aware of drugs and toxins
Reverse other contributing factors

Question 24

When is metabolic acidosis seen regarding GFR?

Answer 24

When GFR <20 mls/min

Question 25

When does anaemia usually manifest in CKD?

Answer 25

When GFR <20mls/min

Question 26

What is the treatment for anaemia?

Answer 26

Iron replacement

Question 27

What is the effect of CKD on bones?

Answer 27

¥ As GFR gets worse
¥ Get high phosphate in the blood
¥ Loss of renal tissue leads to lack of activated vitamin D
¥ Indirect reduction in calcium absorption
¥ Low calcium and raised phosphate
¥ Secondary hyperparathyroidism (elevated PTH)
- In response to hypocalcaemia
¥ Lose Ca2+ from the bones

Question 28

What can be done to manage hyperkalaemia?

Answer 28

Reduce potassium in diet

Change medications that may ‘hold onto’ K+

Question 29

What is a main cause of CKD?

Answer 29

Hypertension

Question 30

How does hypertension cause CKD?

Answer 30

Narrows vessels

Question 31

What is the 2nd commonest cause of CKD?

Answer 31

Diabetes

Question 32

What is azotemia?

Answer 32

High levels of nitrogen containing compounds in the blood

Question 33

How does CKD lead to anaemia?

Answer 33

Erythropotein levels fall
Reduction of RBC
Leading to anaemia