Chronic Kidney Disease

Question 1

What are the common causes of chronic kidney disease?

Answer 1

Diabetes, glomerulonephritis, hypertension, renal artery stenosis, pyelonephritis, reflux nephropathy, congenital, interstitial disease, drugs

Question 2

What is the “triple whammy” of drugs in a renal context?

Answer 2

NSAIDs, ACE (or ARB), thiazide diuretics

Question 3

What are the glomerulonephritis causes of CKD?

Answer 3

IgA nephropathy, Wegener’s granulomatosis, amyloidosis, diabetic glomerulosclerosis, thrombotic thrombocytopenic, purpura, sickle cell disease

Question 4

What are the congenital/inherited causes of CKD?

Answer 4

polycystic kidney disease, alports syndrome, medullary cystic disease, tuberose sclerosis

Question 5

What are the interstitial kidney disease causes of CKD?

Answer 5

reflux nephropathy, TB, schistosomiasis, multiple myeloma

Question 6

what drugs are implicated as causes of CKD?

Answer 6

NSAIDs, ACE inhibitors (or ARB) and thiazide diuretic

Also lithium, radiographic contrast agents, aminoglycosides, gadolinium

Question 7

What is the pathophysiology of hypertension caused CKD?

Answer 7

renal artery thickens and lumen narrows causing ischemic injury to glomerulus
Immune cells release TGF-B - cause regression of mesangial cells and production extracellular matrix
Leads to glomerulosclerosis – impacts ability to filter the blood

Question 8

what is the pathophysiology for diabetic caused CKD?

Answer 8

Excess glucose sticks to protein – non-enzymatic glycation
efferent arteriole becomes stiff and narrow = obstruction and blood build up increased pressure and hyperfiltration
mesangial cells release structural matrix = glomerular sclerosis

Question 9

What are the symptoms of CKD? (17)

Answer 9

Hypertension, Malaise, Loss of appetite, Insomnia, Nocturia and polyuria, Itching, Nausea, vomiting and diarrhoea, Parasthesia, Restless leg syndrome, Bone pain, Peripheral and pulmonary oedema, anaemia, Amenorrhoea, Erectile dysfunction, Bruising, SOB, Haematuria

Question 10

What are the signs of CKD? (8)

Answer 10

Increased skin pigmentation – yellow tinge, Excoriation, Pallor, Hypertension, Postural hypotension, Peripheral oedema, Pleural effusion, Peripheral neuropathy

Question 11

What is the GFR of stage 1?

Answer 11

> 90

Question 12

What is the GFR of stage 2?

Answer 12

60-89

Question 13

What is the GFR of stage 3a?

Answer 13

45-59

Question 14

What is the GFR of stage 3b?

Answer 14

30-44

Question 15

What is the GFR of stage 4?

Answer 15

15-29

Question 16

What is the GFR of stage 5?

Answer 16

<15

Question 17

What is involved in screening of CKD?

Answer 17

BP
U&Es – creatinine end eGFR
Urine for albuminuria

Question 18

What blood tests will be done in CKD? (13)

Answer 18

o	FBC – normochromic, normocytic anaemia
o	ESR – if rasied consider myeloma or vasculitis
o	U&E – rasied urea and creatinine
o	eGFR
o	Glucose
o	Sodium – often low
o	Potassium – raised 
o	Calcium – low (also normal and high)
o	Increased phosphate
o	Rasied alkphos
o	Rasied parathyroid
o	Albumin – often low
o	Serology – hep B, hep C, HIV, c-ANCA, p-ANCA, anti-GMB, complement

Question 19

What features of urinalysis will be explored in CKD?

Answer 19

o	Haematuria – differentiate glomerulonephritis from chronic renal failure
o	Proteinuria – suggests glomerular disease
o	Glycosuria
o	Casts - glomerularnephritis
o	White cells – infection/nephritis
o	Red cells
o	24 cratinine clearance 
o	Urine electolytes
o	Urine osmolarity

Question 20

What imaging should be done for CKD?

Answer 20

Renal USS, renal nucleotide scan, CT, MRI

Question 21

what investigation are done on diagnosis of CKD?

Answer 21

o	Renal tract USS
o	FBC, CRP, ESR
o	Urine ACR
o	Fasting lips and glucose
o	Urine microscopy for dysmorphic red cells, red cell casts or crystals

Question 22

what are the 2 main features of CKD management?

Answer 22

• Investigation – identifying and treating reversible causes

* Limiting disase progression/complications

Question 23

What are the features of hypertension management in CKD?

Answer 23

 ACE inhibitors first line (be aware of potassium)

 Aim for <130/90

Question 24

What are the features of renal bone disease management in CKD?

Answer 24

 If secondary hyperparathyroidism - Vitamin D supplementation (cholecalciferol then calcitrol)
 Hyperphosphatemia – low phosphate diet, calcium carbonate

Question 25

What are the features of CVS management in CKD?

Answer 25

 Statins
 Aspirin – secondary prevention only
 Oral anticoagulants – when indicated rivarxoban preferred to warfarin in CKD

Question 26

what diet changes are made in CKD management?

Answer 26

reduce salt

Question 27

what are the common features of symptom control management in CKD?

Answer 27

o Anameia – replace iron/B12/folate if necessary, consider EPO
o Acidosis – sodium bicarbonate
o Oedema – loop direutics (furesmide)
o Restless legs/cramps – check ferritin – clonzapam or gabapentin may help