Chronic Kidney Disease

Question 1

What are the functions of the kidney?

Answer 1

Body fluid homeostasis
Regulation of vascular tone
Excretory function
Electrolyte homeostasis
Acid base balance
Endocrine function

Question 2

What is the endocrine function of the kidney?

Answer 2

Erythropoeitin
Vitamin D metabolism
Renin

Question 3

How do we assess for kidney damage?

Answer 3

Excretory function
Barrier function
Anatomy

Question 4

How do we measure GFR?

Answer 4

GFR estimating equations
Inulin clearance
Isotop GFR
24hr urine

Question 5

When will creatinine be raised?

Answer 5

Not until 60% of kidney function is lost

Question 6

Creatinine can vary based on what factors?

Answer 6

Age
Ethnicity (AA - higher)
Gender
Weight
Liver function

Question 7

What is stage 1 CKD?

Answer 7

GFR >90

Kidney damage

Question 8

What is stage 2 CKD?

Answer 8

GFR 60-90

Kidney damage

Question 9

What is stage 3a CKD?

Answer 9

GFR 45-60

Moderate impairment

Question 10

What is stage 3b CKD?

Answer 10

GFR 30-45

Moderate impairment

Question 11

What is stage 4 CKD?

Answer 11

15-30

Question 12

What is stage 5 CKD?

Answer 12

<15

Question 13

How is kidney excretion measured?

Answer 13

GFR estimation

Question 14

What proteins are filtered?

Answer 14

Low molecular weight proteins

alpha2 microglobulin

Question 15

How is kidney filtering function assessed?

Answer 15

Urinalysis
(Blood, protein)
Protein quantification
(Protein creatinine ratio)

Question 16

How is kidney reabsorption measured?

Answer 16

Presence of blood or protein in urine

Question 17

How is CKD defined?

Answer 17

Presence of kidney damage (blood, urine, x-ray findings)

GFR <60 for >3months

Question 18

What factors are used to classify CKD?

Answer 18

GFR

Albuminuria

Question 19

What is the prevalence of chronic kidney disease?

Answer 19

Increased with age

8-12%

Question 20

What are the causes of CKD?

Answer 20

Diabetes
Glomerulonephritis
Hypertension
Renovascular disease
Polycystic Kidney disease
Renal vascular disease

Question 21

What are the signs and symptoms of chronic kidney disease?

Answer 21

Pallor - anaemia
Hypertension
Shortness of breath 
Change in kidney shape 
Itch and night cramps
Cognitive impairment
Anorexia 
Uraemic fetor
Urine output change
Haematuria
Proteinuria
Peripheral oedema

Question 22

What are the kidney changes seen in CKD?

Answer 22

Bilateral small kidneys with thinned cortices
Unilateral small kidney
Clubbed calyces, scars
Enlarged cystic kidneys

Question 23

Bilateral small kidneys on imaging suggest what?

Answer 23

Intrinsic disease

Question 24

Unilateral small kidneys on imaging suggest what?

Answer 24

Renal arterial disease

Question 25

Clubbed calyces and cortical scars on renal imaging suggest what?

Answer 25

Reflux with chronic infection | Ischaemia

Question 26

What investigations are useful in detecting the underlying aetiology of CKD?

Answer 26

``` History Examination Blood tests Urine tests Histology/biopsy Radiology Chemistry Haematology Coagulation screen Urinalysis Protein quantification ```

Question 27

What is the clinical approach to CKD?

Answer 27

Detection of underlying disease Slowing rate of renal decline Assessment of complications Preparation for Renal Replacement Therapy

Question 28

How is the rate of renal decline managed?

Answer 28

BP control Control of proteinuria (ACEI/ARBs) Treat underlying cause

Question 29

How is anaemia in CKD treated?

Answer 29

EPO | Iron

Question 30

How is bone disease in CKD managed?

Answer 30

Diet | Phosphate binders

Question 31

How is the patient prepared for end stage renal disease?

Answer 31

Education and Information Selection of modality - HD/PD/transplant/palliation Deciding when to start RRT