Chronic Kidney Disease

Question 1

CKD is defined as impaired renal function for how long?

Answer 1

> 3 months

Question 2

CKD can be diagnosed with or without evidence of kidney damage if the GFR is less than what?

Answer 2

60ml/min

Question 3

Symptoms only tend to occur once what stage of CKD is reached? What GFR does this correspond to?

Answer 3

Stage 4, GFR < 30ml/min

Question 4

End stage renal failure is defined as what?

Answer 4

GFR < 15ml/min or the need for RRT

Question 5

Describe stage 1 CKD?

Answer 5

Normal or increased GFR (> 90ml/min) with other evidence of renal damage

Question 6

What GFR range corresponds to stage 2 CKD?

Answer 6

60 - 89

Question 7

If GFR is > 60ml/min, there must be ‘other evidence of renal damage’ for CKD to be diagnosed. What are some examples of this evidence?

Answer 7

Proteinuria, haematuria, abnormal anatomy or systemic disease

Question 8

CKD is most likely to occur with which type of diabetes?

Answer 8

Type 2

Question 9

For how long after an AKI should an individual’s renal function be monitored for the development of CKD?

Answer 9

2-3 years

Question 10

Uraemia initially causes many general symptoms. What are some examples of these?

Answer 10

N+V/loss of appetite/weight loss, fatigue, pruritus, muscle cramps

Question 11

What are some life-threatening complications of uraemia?

Answer 11

Encephalopathy and pericarditis

Question 12

In the majority of patients, CKD leads to salt and water retention. What symptoms does this cause?

Answer 12

Hypertension and oedema (peripheral and pulmonary)

Question 13

What happens to potassium levels in CKD?

Answer 13

Increased (hyperkalaemia)

Question 14

What happens to calcium levels in CKD?

Answer 14

Decreased (hypocalcaemia)

Question 15

The secretion of what increases to compensate for the loss of calcium in CKD?

Answer 15

Parathyroid hormone (hyperparathyroidism)

Question 16

Hyperparathyroidism ultimately leads to what complication of CKD?

Answer 16

Renal osteodystrophy

Question 17

Patients with CKD are prone to developing which acid-base disorder?

Answer 17

Metabolic acidosis

Question 18

Why do patients with CKD become anaemic?

Answer 18

The kidneys no longer secrete enough erythropoietin

Question 19

CKD may cause what additional symptom in women of child-bearing age?

Answer 19

Amenorrhoea

Question 20

CKD may cause what additional symptom in males?

Answer 20

Impotence

Question 21

What type of anaemia occurs in CKD?

Answer 21

Normochromic, normocytic

Question 22

What pattern is shown on bone biochemistry of individuals with CKD who have developed renal osteodystrophy?

Answer 22

Low calcium, high phosphate, high ALP

Question 23

PTH is typically raised in individuals with what stage of CKD and worse?

Answer 23

Stage 3

Question 24

In most cases of CKD, what happens to the size of the kidneys?

Answer 24

They are small (< 9cm)

Question 25

When would a renal biopsy be indicated in individuals with CKD?

Answer 25

If there is rapidly progressive disease, or if there is an unknown cause with normal sized kidneys

Question 26

What is the target blood pressure for individuals with CKD?

Answer 26

< 130/80

Question 27

All patients with diabetic nephropathy should be given what drug, even if their blood pressure is normal?

Answer 27

ACE inhibitor (or ARB)

Question 28

What happens to renal function when an ACE inhibitor is started?

Answer 28

There is a temporary drop in GFR

Question 29

What is the most important dietary modification for individuals with CKD?

Answer 29

Phosphate reduction

Question 30

What are some examples of foods containing phosphate which should be avoided in individuals with CKD?

Answer 30

Cheese, milk, eggs

Question 31

What medications can be given to reduce the risk of renal bone disease?

Answer 31

Phosphate binders, and calcium and vitamin D supplements

Question 32

Why should vitamin D supplements not be given to individuals with hypercalcaemia?

Answer 32

Risk of vascular calcification

Question 33

If iron/folate/B12 levels are all normal, how should anaemia in CKD be treated?

Answer 33

Epo replacement

Question 34

What medication can be used to help manage symptoms of acidosis in individuals with CKD?

Answer 34

Sodium bicarbonate

Question 35

Sodium bicarbonate treatment should be given with caution in who? Why?

Answer 35

Patients with hypertension, as the increased sodium can raise the blood pressure further

Question 36

How can oedema be managed in patients with CKD both pharmacologically and non-pharmacologically?

Answer 36

Loop diuretics, and a restricted salt/fluid intake

Question 37

What are some medications which may help with symptoms of restless/crampy legs in CKD?

Answer 37

Clonezepam, gabapentin, quinine sulphate