Chronic Kidney Disease

Question 1

Define Chronic Kidney Disease (CKD)?

Answer 1

Progressuve loss of kidney fucntion over a period of months or years
Presence of kidney damage or decreased kidney function (i.e. eGFR < 60 mL/min per 1.73 m^2) for three months or more

Question 2

What is the classification of CKD?

Answer 2

Stage 1: Normal
Stage 2: Mild Impairment 
Stage 3a: Moderate Impairment 
Stage 3b: Moderate Impairment 
Stage 4: Severe Impairment 
Stage 5: Established Renal Failure

Question 3

What is Stage 1 of CKD?

Answer 3

eGFR > 90 ml/min per 1.73 m^2 with other evidence of CKD (microalbuminuria, proteinuria, haematuria, structural abnormalities, biopsy showing glomerulonephritis)

Question 4

What is Stage 2 of CKD?

Answer 4

Mild Impairement:

eGFR 60-89 mL/min per 1.73 m^2 with other evidence of CKD

Question 5

What is Stage 3a of CKD?

Answer 5

eGFR: 45-59 mL/min per 1.73 m^2

Question 6

What is Stage 3b of CKD?

Answer 6

eGFR: 30-44 mL/min per 1.73 m^2

Question 7

What is Stage 4 of CKD?

Answer 7

Severe Impairment

eGFR: 15-29 mL/min per 1.73 m^2

Question 8

What is Stage 5 of CKD?

Answer 8

Established renal failure

eGFR < 15 mL/min per 1.73 m^2 or on dialysis

Question 9

What is CKD mainly associated with in developed countries?

Answer 9

Age
Diabetes mellitus 
Hypertension
Obesity 
Cardiovascular Disease

Question 10

What are the other risk factors of CKD?

Answer 10

Arteriopathic renal disease 
Nephropathies 
Family History
Neoplasia 
Myeloma 
Systemic disease (e.g. SLE)
Smoking 
Chronic use of NSAIDs

Question 11

What is the epidemiology of CKD?

Answer 11

COMMON
Risk increases with age
Often associated with other diseases (e.g. Cardiovascular disease)

Question 12

What are the presenting symptoms of normal CKD?

Answer 12

Often Asymtomatic
May be an incidental finding of a routine blood or urine test
Sexual dysfunction is common

Question 13

What are the symptoms of Severe CKD?

Answer 13

Anorexia
Nausea and vomiting 
Fatigue 
Pruritus 
Peripheral Oedema 
Muscle Cramps 
Pulmonary Oedema

Question 14

What is the problem with CKD?

Answer 14

Physical examination rarely reveals many clues
May show signs of underlying disease (e.g. SLE)
May show complications of CKD (e.g. anaemia)

Question 15

What are the signs of CKD?

Answer 15

Skin pigmentation
Excorciation marks
Pallor 
Hypertension
Peripheral oedema 
Peripheral vascular disease

Question 16

What investigations do we do for CKD?

Answer 16

Assessment of Renal Function
Biochemistry 
Serology 
Urinalysis 
Imaging 
Renal Biopsy

Question 17

What investigations do we do to assess renal function?

Answer 17

Urea
Creatinine
Isotopic GFR

Question 18

What is the problem of Urea as an investigation for CKD?

Answer 18

Not ideal because it varies massively depending on hydration status and diet

Question 19

What are the characteristics of Creatinine as an investigation for CKD?

Answer 19

Useful but has limitations

Renal function can drop considerably with minimal change in serum creatinine

Question 20

What are the characteristics of Isotopic GFR as an investigation for CKD?

Answer 20

GOLD STANDARD but expensive

Question 21

What Biochemistry investigations do we do for CKD?

Answer 21

Glucose - check for undiagnosed diabetes and diabetic control
Potassium - raised
Also check sodium, bicarbonate, calcium, phosphate

Question 22

What antibodies do we test for in CKD?

Answer 22

ANA - SLE
c-ANCA - granulomatosis with polyangiitis (Wegener’s)
Anti-GBM - Goodpasture’s syndrome

Question 23

What other serology’s do we invesigate for CKD?

Answer 23

Hepatitis

HIV

Question 24

What do we look for in Urinalysis for CKD?

Answer 24

Check for proteinuria/haematuria
24 hr urine collection
Serum or urine protein electrophoresis - check for multiple myeloma

Question 25

What Imaging investigations do we do for CKD?

Answer 25

US - check for structural abnormalities
CT/MRI
X-Ray KUB - check for stones