Chronic Kidney Disease

Question 1

How is GFR currently obtained in clinical practice?

Answer 1

• Can be obtained via isotope clearing test but costly and cumbersome, so usually measure serum creatinine and put it into a formulae to estimate GFR (eGFR)

Question 2

How is chronic kidney disease staged? What are the stages?

Answer 2

Staged according to GFR:

1. GFR > 90, kidney damage but normal GFR
2. GFR: 60 - 89, mild reduction in GFR
   3a. GFR: 45-59, moderate impairment
   3b. GFR: 30-44, moderate impairment
3. GFR: 15-29, severely impaired
4. GFR < 15, advanced or on dialysis

Question 3

What are some methods of assessing kidney function?

Answer 3

• eGFR
• Urine dipstick
• Renal Biopsy
• Kidney USS

Question 4

How is chronic kidney disease defined?

Answer 4

• The presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR < 60 that has been present for >3 months

Question 5

What are some common causes of chronic kidney disease (CKD)?

Answer 5

• Polycystic kidney disease
• Diabetes
• Glomerulonephritis
• Hypertension
• Renovascular disease
• Pyelonephritis

Question 6

What is the general clinical approach when treating CKD?

Answer 6

• Detect the underlying aetiology
• Slow the rate of renal decline
• Assess complications related to reduced GFR
• Renal replacement therapy

Question 7

What are some potential therapies to slow the rate of renal decline in CKD patients?

Answer 7

• BP control (most important)

- Control proteinuria (ACE inhibitors / ARBs)

Question 8

What are some possible long term renal replacement therapies?

Answer 8

• Transplantation

- Dialysis (often not recommended in frail elderly people)