Chronic Kidney Disease

Question 1

What are some of the physiological waste products dealt with at the kidney?

Answer 1

Creatinine
Urea
Drugs

Question 2

What endocrine role do the kidneys play?

Answer 2

Produce EPO

Important in VitD metabolism

Question 3

How do we estimate GFR/

Answer 3

Serum creatinine clearance

Question 4

How is creatinine produced?

Answer 4

Break down product of muscle

Question 5

At what stage will creatinine begin to rise?

Answer 5

When GFR is 60% of normal

Question 6

What are the determinants which can alter serum creatinine between individuals?

Answer 6

Muscle mass
Age 
Gender 
Weight 
Ethnicity

Question 7

What equations are used to estimate GFR from serum creatinine?

Answer 7

Cockcroft Gault

MDRD 4 variable equation (clinical)

Question 8

What CKD staging will be observed in individual with >90 GFR?

Answer 8

1 - Normal

Question 9

What CKD staging will be observed in individual with 60-89 GFR?

Answer 9

2 - mild reduction

Question 10

What CKD staging will be observed in individual with 30-45 GFR?

Answer 10

3- Moderately impaired

Question 11

What CKD staging will be observed in individual with 15-29 GFR?

Answer 11

4- Severely impaired

Question 12

What CKD staging will be observed in individual with <15 GFR?

Answer 12

5- Advanced or on dialysis

Question 13

How do we measure filtration function of the kidneys?

Answer 13

Use estimation of GFR (eGFR) from creatinine blood tests

Question 14

What abnormalities may you seen in urine?

Answer 14

Blood

Protein

Question 15

What test allows for the identification of blood/protein in urine?

Answer 15

Urinalysis (dipstick)

Question 16

How can you quantify protein in urine?

Answer 16

PCR (protein creatinine ratio)

Question 17

What is the definition of CKD?

Answer 17

Defined by either the presence of kidney damage or GFR <60 that is present for >3 months

Question 18

Which area of population most likely to get CKD?

Answer 18

Elderly

Question 19

What are the main risk factors for developing CKD?

Answer 19

Diabetes 
Glomerulonephritis 
Hypertension 
Renovascular disease 
Polycystic kidney disease

Question 20

What investigations may we do to understand the underlying aetiology of CKD?

Answer 20

FBC
U&Es
Creatinine
LFTs
Urinalysis 
USS
Renal biopsy

Question 21

Renal disease is often ____.

Answer 21

Asymptomatic

Question 22

What are the benefits of USS?

Answer 22

No radiation

Non-invasive

Question 23

What can be easily identified with USS?

Answer 23

Hydronephrosis

Question 24

What is the most important thing to control when trying to decrease the decline of renal function?

Answer 24

Blood pressure

Question 25

What drugs may be given in CKD to reduce BP?

Answer 25

ACE-inhibitors

ARBs

Question 26

Why do CKD patients become anaemic?

Answer 26

Stop producing EPO required for RBC production

Question 27

What vitamin may CKD patients become deficient in?

Answer 27

VitD

Question 28

Why might a patient with CKD become acidotic?

Answer 28

Unable to produce HCO

Question 29

What are the different ways to prevent fluid overload in CKD patient?

Answer 29

Reduce salt intake
Fluid restriction
Diuretics

Question 30

What other system in the body is usually affected in renal patients?

Answer 30

CVS

Question 31

In kidney disease, why make bone disease be observed?

Answer 31

Elevated Phosphate levels which leads to resorption of Ca from bones