Chronic Kidney Disease

Question 1

Define:

Answer 1

Impaired renal function for more than 3 months +/- evidence of kidney damage
(eGFR <60ml/min)

Question 2

Aetiology/risk factors:

Answer 2

GOD CHAP (Common causes in the developed world)

Glomerularnephritis
Obesity
Diabetes (T2>T1)

Cardiovascular disease
Hypertension/ renovascular disease
Age
Pylenonephrirtis

Other risk factors:

• Family history
• Nephropathies
• Neoplasia
• myeloma
• SLE
• Smoking
• SLE

Question 3

Epidemiology:

Answer 3

Common

Risk increases with age

Common with other chronic diseases

Question 4

Symptoms:

Answer 4

Usually asymp and found on an incidental urine or blood test.

Severe CKD:

• Nausea
• Vomiting
• Anorexia
• Fatigue
• Pruritis
• Peripheral/pulmonary oedema
• Muscle cramps
• Sexual dysfunction

Question 5

Signs:

Answer 5

There are not many signs but there may be signs of the underlying cause or complications.

Pallor
Uraemic colour 
Skin pigmentation 
Purpura 
Hypertension 
Peripheral oedema 
PVD
Fluid overload 
Excortation marks

Question 6

Investigations:

Answer 6

Urea - this is not ideal as is affected by dehydration

Creatinine - also not always ideal

Isotropic GFR - GOLD STANDARD BUT EXPENSIVE.

Bloods - ESR, Hb, U + Es, glucose (to check for undiagnosed diabetes)

K+ - to avoid arrhythmia

Sodium, calcium, phosphate, bicarbonate.

ANA - SLE
Anti-GBM - good pastures

Hep and HIV screen

Urinanalysis

US, CT, MRI and X-ray KUB

Renal biopsy if unclear