Chronic Kidney Disease

Question 1

What is obstructive uropathy?

Answer 1

Blockage of the urinary flow causing hydronephrosis

Question 2

Both kidneys are always affected by obstructive uropathy. T/F?

Answer 2

False - sometimes it is only one kidney

Question 3

What are the common causes of obstructive uropathy?

Answer 3

Renal stones
BPH
Prostate cancer
Bladder tumours

Question 4

How does obstructive uropathy lead to kidney damage?

Answer 4

The blockage of urinary flow causes back pressure of the kidney which can decrease renal blood flow, decrease GFR and up-regulate RAAS, leading to atrophy and apoptosis of the renal tubules and interstitial fibrosis

Question 5

How is chronic kidney disease defined?

Answer 5

A pathological normality of the kidney (e.g. haematuria and/or proteinuria) or a reduction in GFR <60ml/min for greater than 3 months

Question 6

Chronic kidney disease is always symptomatic. T/F?

Answer 6

FALSE - it is often asymptomatic

Question 7

What are the two most common causes of chronic kidney disease?

Answer 7

Diabetes

Hypertension

Question 8

What are the less common causes of chronic kidney disease?

Answer 8

Polycystic kidney disease
Obstructive uropathy
Glomerular nephrotic and nephritic syndromes

Question 9

What are the signs and symptoms of CKD?

Answer 9

Fatigue (related to anaemia associated with CKD)
Nausea and vomiting
Oedema
Anorexia (protein)
Pruritus
Uraemia
Seizures/coma in advanced stages of uraemia

Question 10

What investigations can be done for chronic kidney disease?

Answer 10

Serum creatinine
GFR
Urinalysis - look for haematuria and proteinuria
Renal ultrasound - evaluate kidney size, mass session, urinary obstruction, renal blood flow and presence of stones

Question 11

All aetiologies of chronic kidney disease are progressive. T/F?

Answer 11

True

Question 12

What is the range of GFR which would classify someone as stage 1 chronic kidney disease if there was also the presence of pathological changes?

Answer 12

> 90ml/min

Question 13

What is the range of GFR which would classify someone as stage 2 chronic kidney disease if there was also the presence of pathological changes?

Answer 13

60-89 ml/min

Question 14

What is the range of GFR which would classify someone as stage 3 chronic kidney disease?

Answer 14

30-59 ml/min

Question 15

What is the range of GFR which would classify someone as stage 4 chronic kidney disease?

Answer 15

15-29 ml/min

Question 16

What is the range of GFR which would classify someone as stage 5 chronic kidney disease?

Answer 16

<15 ml/min

Question 17

The major cause of death for patients with chronic kidney disease is cardiovascular disease. Treatment therefore focusses of reduced cardiovascular risk factors. What does this involve?

Answer 17

Optimising glycemic control
Optimising blood pressure - use of ACE inhibitors and angiotensin-II receptor blockers
Use of lipid-lowering agents such as statins
Reduction of proteinuria

Question 18

Anaemia is an important comorbidity of chronic kidney disease. In the absence of other causes of anaemia, how might this be treated?

Answer 18

EPO-stimulating agents

Question 19

Secondary hyperparathyroidism is an important comorbidity of chronic kidney disease. How might this be treated?

Answer 19

Dietary restrictions

Phosphate binding medications

Question 20

Patients with stage 4 and 5 chronic kidney disease require kidney replacement therapies. What are the three options for this?

Answer 20

Haemodialysis
Peritoneal dialysis
Kidney transplantation

Question 21

Kidney transplantation is indicated once the GFR is less than…?

Answer 21

20ml/min