Chronic Kidney Disease

Question 1

What is Chronic Kidney Disease?

Answer 1

Abnormal kidney structure or function, present for > 3 months, with implications for health

Question 2

What are the risk factors of CKD?

Answer 2

• Age
• Ethnicity (black)
• Hypertension
• Diabetes
• Smoking
• Obesity

Question 3

What are the most common causes of CKD?

Answer 3

=> Diabetic nephropathy:

• Increase in blood glucose
• Damage to the glomerulus via mesengial proliferation and basement membrane thickening

=> Hypertension:

• Development of atherosclerosis
• Narrowing of renal artery
• Leads to ischaemia and glomerulosclerosis

=> Polycystic Kidney Disease

=> Chronic glomerulonephritis

=> Chronic Pyelonephritis

Question 4

What are the clinical features of Chronic Kidney Disease?

Answer 4

• Anaemia (due to drop in EPO production)
• Pruritis (severe itching due to hypocalcaemia)
• Mineral bone disease
• Nausea and vomiting
• Anorexia
• Oedema (sodium and water retention)

=> More on Mineral Bone Disease:

• Occurs due to lack of vitamin D and build up of phosphate
• High phosphate, low vitamin D and low calcium can lead to secondary hyperparathyroidism

Question 5

What are the clinical features of polycystic kidney disease?

Answer 5

• Pain or tenderness in abdomen or back or sides
• Skin easily bruised
• Kidney stones
• Frequent infection
• Haematuria
• UTIs

Question 6

What are the investigations in suspected CKD?

Answer 6

=> Bloods

• U&E
• Hb
• Glucose

=> Urinanalysis

• Haematuria
• Proteinuria

=> Ultrasound
- Smaller kidneys

=> Biopsy

=> Calculating eGFR

Question 7

What is the management of CKD?

Answer 7

=> Referral to Nephrology:

• Stage 4 or 5 CKD
• Moderate proteinuria (A:CR > 70mg/mmol) unless due to DM
• Proteinuria (A:CR > 30 mg/mmol) with haematuria
• Declining GFR
• Hypertension poorly controlled despite ≥ 4 anti-hypertensive drugs
• Genetic cause of CKD

=> Treatment to slow renal disease progression:

• Target systolic BP < 140mmHg and diastolic BP < 90mmHg, if DM or proteinuria then < 130/80
• Glycaemic control
• Lifestyle
• Offer RAAS antagonists

=> Treat the renal complications of CKD:

=> Anaemia
- Iron therapy IV or EPO stimulating agent

=> Acidosis
- Sodium bicarconate in patients with eGFR < 30 and low sodium bicarbonate levels

=> Oedema
- Restrict sodium and fluid intake. Combination of loop diuretic + thiazide

=> Mineral Bone Disease

• 1st: reduced dietary intake of phosphate
• Phosphate binders eg. Sevelamer
• Vit D supplements: Alfacalcidol
• Parathyroidectomy

=> Restless leg syndrome

• Good sleep hygiene
• Give gabapentin/pregabalin/dopamine agonists in severe cases

Question 8

What are the different stages of CKD?

Answer 8

=> Stage 1

• GFR > 90ml/min
• Some signs of kidney damage

=> Stage 2

• GFR 60-90 ml/min
• Some signs of kidney damage

=> Stage 3a

• GFR 45-59 ml/min
• Moderate reduction in kidney function

=> Stage 3b

• GFR 30-44 ml/min
• Moderate reduction in kidney function

=> Stage 4

• GFR 15-29 ml/min
• Severe reduction in kidney function

=> Stage 5

• GFR < 15 ml/min
• Dialysis or kidney transplant may be needed

Question 9

What factors affect eGFR values?

Answer 9

• Pregnancy
• Muscle mass
• Eating red meat 12 hours prior to sample

Question 10

What are the most common cause of death in CKD?

Answer 10

• Cardiovascular disease