Chronic Kidney Disease

Question 1

What is a chronic kidney disease?

Answer 1

An umbrella term describing a large spectrum of diseases

Abnormalities/ damage to the kidney structure present for more than 3 months

Question 2

What are the ways to diagnose CKD?

Answer 2

Kidney structure - kidney biopsy

Kidney function - GFR < 60 ml/min/1.73m2

Damage biomarkers

Question 3

What are the causes of CKD?

Answer 3

Idiopathic - unknown

Hypertension

Diabetic nephropathy

IgA nephropathy

Question 4

What is a common feature of CKD following treatment of the underlying cause?

Answer 4

Even after a cause of CKD has been treated - kidney function continues to decline as they scar over time

Question 5

Pathogenesis of CKD

Answer 5

1. Glomerulus becomes damaged
2. Since the glomerulus supplies the tubules -> nephrons become damaged and ischaemic
3. This triggers inflammation - deposition of collagen
4. Cells around the tubule change phenotype - become more fibrotic = interstitial fibrosis
5. Loss of ischaemic nephron is buffered by the rest of the kidney
6. Blood supply to the healthy nephrons increases
7. Proteins leak from the blood to the tubule = proteinuria
8. Increased P in the glomeruli damages the blood tubules
9. Proteins in tubules change phenotype to inflammatory proteins
10. Infiltration of inflammatory cellls and pro-fibrotic changes in the cells that make up the interstitium = fibrosis
11. Loss of nephrons
12. Cycle of fibrosis and worsening scarring

Question 6

What is the main feature of chronic kidney failure?

Answer 6

Irreversible depletion of nephrons

Question 7

How to treat CKD

Answer 7

Treat the underlying disorder

Control blood sugar levels in patients

Immunosuppression in glomerulonephritis

Question 8

What is a system that is often targeted in the treatment of CKD?

Answer 8

Renin-angiotensin system

Question 9

What does the renin-angiotensin normally cause?

Answer 9

Vasoconstriction

Question 10

Which drugs target the renin-angiotensin system?

Answer 10

Renin inhibitor

ACE inhibitor

Angiotensin 2 receptor blocker

Question 11

Why is the renin-angiotensin system the best system to target in order to reduce renal BP?

Answer 11

Specific to for glomerular pressure

Only affects the kidney

Question 12

What is essential to control in order to prevent patients from reaching end-stage renal disease?

Answer 12

Blood pressure