Chronic Kidney Disease

Question 1

What is this?

Answer 1

Impaired renal function for > 3 months, or, GFR <60ml/min/1.73m2 for >3 months with or without evidence of kidney damage.

Question 2

when do symptoms typically occur?

Answer 2

At stage 4 (GFR = <30)

Question 3

End stage renal failure means?

Answer 3

GFR = <15ml/min/1.73m2 or need for renal replacement therapy (RRT - Dialysis or transplant)

Question 4

How do we classify CKD?

Answer 4

eGFR

ACR

Question 5

What does ACR do?

Answer 5

Albumin - Creatinine Ratio provides depiction of how much albumin being released into urine (should just be in plasma) Indicated towards end stage renal failure or when eGFR is particularly low, since creatinine only rises significantly <60ml/min

Question 6

eGFR stage 1 =

Answer 6

> 90ml/min

Question 7

stage 2 =

Answer 7

60-89ml/min

Question 8

stage 3 =

Answer 8

30-59ml/min

Question 9

stage 4 =

Answer 9

15-29ml/min

Question 10

stage 5 =

Answer 10

<15 established renal failure

Question 11

Majority of cases are caused by….

Answer 11

Diabetes
Hypertension
Glomerulonephritis

Question 12

Other causes of CKD =

Answer 12

Malignancy
Anatomical Abnormality of renal tract
Hereditary Disease (e.g. polycystic kidney disease)

Question 13

Patients with CKD often present as …

Answer 13

asymptomatic (until GFR = <30ml/min)

Question 14

Symptoms are …

Answer 14

Non Specific:

• tired
• poor appetite
• itch
• sleep disturbance (nocturia)

Question 15

Signs are …

Answer 15

Pallor
HT
FLuid overload
Peripheral Neuropathy

Question 16

4 aspects of management are

Answer 16

Slow Progression
Reduce CVS risk
Identify and treat Complications
Prepare for Renal Replacement Therapy

Question 17

Slow progression by…

Answer 17

giving ACEi or ARB to lower BP and proteinuria
Maintaining good glycaemic control
Adjusting Diet

Question 18

Reduce CVS risk by…

Answer 18

Giving statins to lower lipids

Stop smoking

Question 19

Examples of complications:

Answer 19

Anaemia
Bone Disease
Hyperkalaemia

Question 20

Management of anaemia?

Answer 20

Erythropeotien produced by kidneys is declined in CKD so…

• Assess iron status, vit B12 + folate levels and replace if necessary
• Still Anaemic then give RECOMBINANT HUMAN ERYTHROPOIETIN (injected)

Question 21

Management of bone disease?

Answer 21

Vit D hydroxylation is impaired in CKD > reduces Ca absorption (hypocalcaemia + hyperphosphataemia) > secondary hyperparathyroidism
So parathyroid hormone takes Ca from bones > boney pathology
Give ALFACALCIDOL (hydroxylated Vit D)
Phosphate Binders + Phosphate reduced diet

Question 22

Management of Hyperkalaemia?

Answer 22

avoid NSAIDS + K sparing diuretics + Gentamicin + Contrast. Give Calcium gluconate to stabilise myocardium + insulin/dextrose to drive K intracellularly

Question 23

4 Renal Replacement Therapy options?

Answer 23

Haemodialysis
Peritoneal Dialysis
Transplantation
Conservative Management

Question 24

When is dialysis indicated?

Answer 24

when GFR = 20ml/min

Question 25

best from of access in haemodialysis

Answer 25

Arteriovenous fistula