Chronic Kidney Disease

Question 1

What criteria are taken into consideration when assessing kidney function?

Answer 1

Filtration (excretory) function
Filtration (barrier) function
Anatomical abnormalities

Question 2

How is the excretory function of the kidneys measured?

Answer 2

Measurement of:
Inulin clearance
Isotope GFR
24 hr urine collection plus blood test
GFR estimating calculations

Question 3

When does creatinine begin to rise above normal levels?

Answer 3

When 60% of the kidney function is lost

Question 4

How is the barrier function of the kidney assessed?

Answer 4

Check for presence of blood or protein in the urine

Question 5

How is the anatomy of the kidneys assessed?

Answer 5

Histology and imaging

Question 6

How is chronic kidney disease defined?

Answer 6

The presence of kidney damage or a GFR <60ml/min/1.73m^2 that is present for at least three months

Question 7

What are the causes of chronic kidney disease?

Answer 7

Diabetes (MOST COMMON)
Glomerulonephritis
Hypertension
Renovascular disease
Polcystic kidney disease

Question 8

What are the symptoms of chronic kidney disease?

Answer 8

Presence of risk factors
Fatigue
Oedema
Nausea +/- vomiting
Pruritis
Anorexia

Question 9

What are the main steps in the management of chronic kidney disease?

Answer 9

Detection of the underlying aetiology
Slowing the rate of renal decline
Assessment of complications related to reduced GFR
Preparation for renal replacement therapy

Question 10

What investigations can be done to try and determine the underlying aetiology of chronic kidney disease?

Answer 10

Blood tests
Urine tests
Histology (renal biopsy)
Imaging (ultrasound)

Question 11

What steps can be taken to try and decrease the rate of renal decline in chronic kidney disease?

Answer 11

Control of blood pressure (MOST IMPORTANT)
Control proteinuria- ACE inhibitors/ARBs
Treat underlying cause

Question 12

What are the potential complications associated with a reducing GFR and how is each avoided?

Answer 12

Acidosis- bicarbonate
Anaemia- EPO and iron
Bone disease- Diet and phosphate binders
Cardiovascular risk- BP, aspirin, cholesterol, exercise, weight
Death and dialysis
Electrolyte imbalance- diet and consider drugs
Fluid overload- salt/fluid restrictions, loop diuretics
Gout
Hypertension- weight, diet, fluid balance, drugs
Iatrogenic issues

Question 13

What steps can be taken to prepare somebody for renal replacement therapy?

Answer 13

Give education and information
Selection of modality- PD, HD, transplant
Planning access
Deciding when to start RRT