Chronic Kidney Disease

Question 1

How is chronic kidney disease defined?

Answer 1

GFR <60ml/min/1.73m^2 for 3 months or more

Question 2

eGFR is a useful measure of kidney function in pregnancy. T/F?

Answer 2

False

Question 3

Describe stage one CKD

Answer 3

GFR >90 with evidence of kidney damage

Question 4

Describe stage two CKD

Answer 4

GFR 60-89 with evidence of kidney. damage

Question 5

Describe stage three CKD

Answer 5

GFR 30-59

Question 6

Describe stage four CKD

Answer 6

GFR 15-29

Question 7

Describe stage five CKD

Answer 7

GFR <15

Question 8

How much protein in the urine per day can be considered normal?

Answer 8

<150mg/day

Question 9

What phsyiological causes can result in 1+ proteinuria on dipstick?

Answer 9

Fever

Exercise

Question 10

How is proteinuria quantified?

Answer 10

24 hour urine collection (not common practice, but gold standard)
Protein:creatinine ratio
Albumin:creatinine ratio

Question 11

How is albuminuria defined?

Answer 11

Albumin:creatinine ratio >30

Question 12

What is the nephrotic range of proteinuria on protein:creatinine ratio?

Answer 12

> 300

Question 13

If there is heavy albuminuria, what test should be used to follow the patient’s progress?

Answer 13

Protein:creatinine ratio

Question 14

Give examples of causes of CKD

Answer 14

Diabetic nephropathy
Renovascular disease/ischaemic nephropathy
Chronic glomerulonephritis
Reflux nephropathy/chronic pyelonephritis
ADPKD
Obstructive uroapthy

Question 15

What are. the symptoms of advanced CKD?

Answer 15

Pruritus
Nausea
Anorexia
Weight loss
Fatigue
Leg swelling
Breathlessness
Nocturia
Joint/bone pain
Confusion

Question 16

What are the signs of advanced CKD?

Answer 16

Peripheral and pulmonary poedema
Pericardial rub
Rash/excoriation
Hypertension
Tachypnoea
Cachexia
Pallor/lemon yellow tinge

Question 17

How can the progression of CKD be slowed?

Answer 17

Agressive bp control
Good diabetic control
Smoking cessation
Diet
Lowering cholesterol
Treating acidosis

Question 18

Which antihypertensives should be used in CKD?

Answer 18

ACE inhibitors or ARBs

Question 19

There will be an initial reduction of eGFR of up to 25% with ACE inhibitor/ARB therapy in CKD. T/F?

Answer 19

True - this is acceptable as it reflects a decrease in glomerular pressure which will improve kidney disease

Question 20

Anaemia in CKD is particularly common when eGFR falls to…?

Answer 20

<30

Question 21

How should anaemia in CKD be treated?

Answer 21

Iron, B12 and folate replacement
Darbepoitin alfa 30 micrograms every 2 weeks
Targets Hb 100-120g/l

Question 22

What is the target haemoglobin in CKD?

Answer 22

100-120 g/l

Question 23

How can secondary hyperparathyroidism as a result of CKD be treated?

Answer 23

Replacement of activated vitamin D - 0.25 micrograms alfacalcidol
Magnesium sipplements
Phosphate bindings - calcium carbonate/acetate, sevelamer, lanthanum, aluminium
Cicimemetic e.g. cinacalet
Parthyroiectomy

Question 24

What is the target phosphate in secondary hyperparathyroidism due to CKD?

Answer 24

0.9-1.5 mol/l

Question 25

When is dialysis started in CKD?

Answer 25

eGFR 5-10 ml/min/1.73m^2

Question 26

There is no benefit to outcomes to starting dialysis early in CKD. T/F?

Answer 26

True