Chronic Kidney Disease

Question 1

what can cause CDK (6)

Answer 1

DIABETES, HYPERTENSION, glomerulonephritis, vascular (renal artery stenosis, vasculitis), tubulointersitial, post renal eg ca.culi

Question 2

what are symptoms of CDK (11)

Answer 2

N+V, anorexia, weight loss, fatigue, itch, altered taste, restless, confusion, muscle weakness, fatigue, pain: bony, neuropathic, ischaemic, visceral

Question 3

what are signs of CDK (9)

Answer 3

anaemia, weight loss, jaundice, uraemic frost, twitching pericardial rub, kussmaul breathing (met acidosis), osteomalacia, hyperkalaemia

Question 4

how does CDK cause anaemia

Answer 4

decreased erythropoietin production

Question 5

what is stage G1 of CDK

Answer 5

eGFR>90, normal kidney function but abnormal urine/ structure/ genetic findings

Question 6

what is stage G2 of CDK

Answer 6

eGFR 60-89, mildly reduced kidney function with abnormal urine/ structure/ genetic findings

Question 7

what is stage G3 of CDK

Answer 7

a: eGFR 45-59, b: 30-44 - moderately reduced function

Question 8

what is stage G4 of CDK

Answer 8

eGFR 15-29: severely reduced function

Question 9

what is stage G5 of CDK

Answer 9

eGFR < 15 - established renal failure

Question 10

how is progression to CDK monitored for after an AKI

Answer 10

after AKI monitor for 2-3 years (even if serum creatinine normal)

Question 11

what is accelerated progression to CKD

Answer 11

sustained decrease in GFR>25% AND change in GFR category within 12 months /// OR sustained decrease in GFR of 15ml/min/year

Question 12

risk factors for development of CKD

Answer 12

CVD, proteinuria, AKI, hypertension, diabetes, smoker, black/ asian, NSAID use, untreated urinary outflow obstruction

Question 13

renal consequences of CKD (9)

Answer 13

local pain, haemorrhage, haematuria, proteinuria, impaired salt and water absorption, hypertension, electrolyte imbalance, AB imbalance, ESRD

Question 14

extra-renal consequences of CDK (4)

Answer 14

CVD, mineral and bone disease, anaemia, nutritional deficiencies

Question 15

how do you manage CVD in CDK

Answer 15

lifestyle: smoking, weight loss, exercise, low salt diet // control hypertension // consider statin + aspirin

Question 16

how do you manage hypertension in CKD

Answer 16

aim for <140 (<130 if diabetic), ACEi and ARBs, 20mg atorvostatin

Question 17

what effect does CKD have on calcium, phosphate, PTH, Vit D and FGF23

Answer 17

decreased: calcium, Vit D // increased: phosphate, PTH, FGF23

Question 18

what can CKD mineral bone disease result in

Answer 18

hyperparathyroidism, vascular calcifcation, bone fractures, CV risk

Question 19

how do you manage CKD mineral bone disease

Answer 19

diet: phosphate, salt, potassium, fluid reduction // alfacaldidol (vit D), phosphate binders, cincalcet (reduced PTH)

Question 20

how do you treat anaemia in CKD

Answer 20

erythropoiesis stimulating agents (ESA), ferric carboxymaltrose, iron sucrose

Question 21

how do you treat ESRD

Answer 21

dialysis and transplant