chronic kidney disease

Question 1

definition

Answer 1

Proteinuria or haematuria, and/or a reduction in the glomerular filtration rate, for more than 3 months’ duration.

The most common causes are diabetes mellitus and hypertension.

The majority of people are asymptomatic, and the diagnosis is determined only by laboratory studies.

Glycaemic control for diabetic nephropathy and optimisation of blood pressure are key in slowing the progression of disease.

Increased risk for cardiovascular disease.

Question 2

symptoms

Answer 2

Anorexia, nausea, malaise, pruritus. Later: diarrhoea, drowsiness, convulsions, coma.

Question 3

causes

Answer 3

Diabetes mellitus and hypertension are the two most common causes.

• Vascular disease: Hypertension, renal artery atheroma, vasculitis.
• Glomerular disease: Glomerulonephritis, diabetes, amyloid, SLE.
• Tubulointerstitial disease: Pyelonephritis/interstitial nephritis, nephrocalcinosis, tuberculosis.
• Obstruction and others: Myeloma, HIV nephropathy, scleroderma, gout, renal tumour, inborn errors of metabolism (e.g. Fabry’s disease).
• Congenital/inherited: Polycystic kidney disease, Alport’s syndrome, congenital hypoplasia.

Question 4

investigations

Answer 4

1st investigations:

• serum creatinine
• urinalysis
• urine microalbumin
• renal USS
• estimation of GFR

others:

• renal biopsy (to find cause)
• plain abdominal radiograph
• CT abdo
• MRI abdo

Question 5

signs

Answer 5

Systemic: Kussmaul’s breathing (acidosis), signs of anaemia, oedema, pigmentation, scratch marks.
Hands: Leuconychia, brown line at distal end of nail.
There may be an arteriovenous fistula (buzzing lump in wrist or forearm).

Signs of complications (e.g. neuropathy, renal bone disease).