Chronic Kidney Disease

Question 1

what is chronic kidney disease

Answer 1

abnormal kidney function and/or structure

Question 2

what does moderate-severe CKD increase the risk of

Answer 2

acute kidney injury
falls
frailty
mortality

Question 3

what is needed to diagnose CKD

Answer 3

minimum of 2 samples with raised creatinine 90 days apart

Question 4

what is the best measure of renal function

Answer 4

eGFR

Question 5

what is eGFR based on

Answer 5

serum creatinine level
age
sex
race

Question 6

how many stages of CKD are there

Answer 6

5

Question 7

what is stage 1 CKD

Answer 7

eGFR >90

normal kidney functions

urine findings or structural abnormalities point to kidney disease

Question 8

what is stage 2 CKD

Answer 8

eGFR 60-89

mildly reduced kidney function

urine findings or structural abnormalities or genetic traits point to kidney disease

Question 9

what is stage 3a CKD

Answer 9

eGFR 45-59

moderately reduced kidney function

Question 10

what is stage 3b CKD

Answer 10

eGFR 30-44

moderately reduced kidney function

Question 11

what is stage 4 CKD

Answer 11

eGFR 15-29

severely reduced kidney function

Question 12

what is stage 5 CKD

Answer 12

eGFR <15

established renal failure

Question 13

what is the albumin creatinine ration (ACR)

Answer 13

a semi quantitive measure of glomerular damage

Question 14

what is ACR category A1

Answer 14

<3

Question 15

what is ACR category A2

Answer 15

3-30

Question 16

what is ACR category A3

Answer 16

> 30

Question 17

what follow up should a patient have after an acute kidney injury

Answer 17

monitoring for progression to CKD for 2-3 years after the acute kidney injury

Question 18

when is eGFRcystatinC used at initial diagnosis

Answer 18

to confirm/rule out CKD in people with a eGFR of 45-59 but no other marker of CKD

Question 19

what is accelerated progression of CKD

Answer 19

sustained decrease in GFR of 25% or more AND change in GFR category within 12 months

OR

sustained decrease in GFR or 15mil/min

Question 20

what risk factors are associated with CKD progression

Answer 20

cardiovascular disease
proteinuria 
acute kidney injury 
hypertension 
diabetes
smoking
African, African Caribbean or asian family origin 
chronic use of NSAIDs
untreated urinary outflow tract obstruction

Question 21

what BP should you aim for in people with CKD

Answer 21

systolic bp <140 and diastolic <90

Question 22

what BP should you aim for in people with CKD and diabetic

Answer 22

systolic <130

diastolic <80

Question 23

what effect can RAAS inhibition (ACEi/ARB) have on CKD

Answer 23

can reduced GFR and increase serum creatinine at the start

do not stop meds if the GFR decrease is <25% and the serum creatinine increase is <30%

Question 24

what should you give CKD patients to reduce the risk of secondary CVD

Answer 24

Atorvastatin 20mg

Question 25

when should you increase dose of atorvastatin in CKD patients

Answer 25

if >40% drop in non-HDL cholesterol or eGFR is 30ml/min or more

Question 26

what are the 3 most common causes of CKD

Answer 26

diabetes hypertension glomerulonephritis

Question 27

what can cause primary glomerulonephritis

Answer 27

``` membranous (autoimmune) IgA primary FSGS (focal segmental glomerulosclerosis) ```

Question 28

what can cause secondary glomerulonephritis

Answer 28

``` diabetes lupus FSGS due to HIV Heroin Obesity ```

Question 29

what are some vascular causes of CKD

Answer 29

- Renal artery stenosis - Ischaemic/hypertensive nephrosclerosis - microvascular disease (thrombosis which can be caused by haemolytic uremic syndrome or thrombocytopaenia purpura) - small vessel vasculitis

Question 30

what are the 3 types of small vessel vasculitis

Answer 30

granulomatosis with polyangitis microscopic polyangitis eosinophilic granulomatosis with polyangitis

Question 31

what are some causes of tubulointerstitial (problems are in the tubules n collecting ducts and stuff) CKD

Answer 31

acute interstitial nephritis tubulointerstitial nephritis and uveitis autosomal dominant polycystic kidney disease reflux nephropathy

Question 32

what are some causes of post renal (obstructive) CKD

Answer 32

Calculi - renal - ureteric - bladder Prostate - benign hyperplasia - cancer Bladder - malignancy - bladder wall thickening urethral stricture

Question 33

what are some clinical signs of CKD

Answer 33

Anaemia (due to lack or erythropoietin production) weight loss in advanced uraemia: ``` lemon yellow uraemic frost (urea deposited on skin) twitching encephalopathic flap confusion pericardial rub or effusion kussmaul breathing ```

Question 34

what are some uraemic symptoms of CKD

Answer 34

``` Nausea and vomiting anorexia weight loss itch fatigue altered rase restless legs muscle twitching difficulties concentrating confusion ```

Question 35

what renal problems can CKD lead to

Answer 35

local pain/haemorrhage/infection urinary - haematuria/proteinuria impaired salt and water handling hypertension electrolyte abnormalities acid-base disturbance

Question 36

what are some extra renal problems causes by CKD

Answer 36

cardiovascular disease mineral and bone disease anaemia nutrition problems

Question 37

what are the treatment options for end stage renal disease

Answer 37

Haemodialysis Peritoneal dialysis Transplantation or conservative management

Question 38

how do you moderate the increased risk of CVD caused by CKD

Answer 38

``` smoking cessation weight loss aerobic exercise limiting salt intake control prophylaxis lipid lowering therapies aspirin ```

Question 39

how does CKD lead to an increase risk of mineral and bone disease

Answer 39

through changes in ``` calcium phosphate PTH Vit D Fibroblast growth factor ```

Question 40

what consequences does CKD-mineral bone disease have

Answer 40

``` hyperparathyroidism vascular calcification bone pain fractures CV events lower quality of life high morbidity and mortality ```

Question 41

how do you manage mineral bone disease in CKD

Answer 41

``` phosphate restriction salt reduction potassium restriction fluid restriction dietary restrictions ``` correct metabolic acidosis give alfacalcidol (active form of vit d) phosphate binders calcimimetics

Question 42

what group of CKD patients are more likely to get anaemia

Answer 42

those in CKD 3a >