Chronic kidney disease

Question 1

What is CKD?

Answer 1

Chronic kidney disease (CKD), also known as chronic renal failure, is defined as abnormalities of kidney structure or function, present for ≥3 months, with implications for health.

Question 2

What are risk factors for CKD?

Answer 2

age >50 years, male sex, black or Hispanic ethnicity, family history or inherited kidney disease, smoking, obesity, long-term analgesic use, diabetes, hypertension, and autoimmune disorders like vasculitis and lupus.

Question 3

What are the common causes of CKD?

Answer 3

Diabetes and hypertension

Structural renal disease, recurrent calculi, BPH, drugs…

Question 4

What are signs and symptoms of CKD?

Answer 4

• Pruritus
  
  • Nausea, anorexia, weight loss
  • Fatigue
  • Leg swelling
  • Breathlessness
  • Nocturia
  • Joint/bone pain
  • Confusion
  • Peripheral, periorbital, and pulmonary oedema
  • Pericardial rub
  • Rash/excoriation
  • Hypertension
  • Tachypnoea
  • Cachexia
  • Pallor &/or lemon yellow tinge

Question 5

What investigations in CKD?

Answer 5

U+Es:
Cr
FBC: anaemia 
eGFR
GN screen and immunology

Urine: urinalysis and albumin: extent of damage (ACR)

Imaging: renal US can show kidney atrophy.

Question 6

What treatments to slow disease progression?

Answer 6

ACEi/ARC reduce mortality.

Glycaemic control if diabetic

Question 7

What treatments for renal complications of CKD?

Answer 7

Darbepoeitin (EPO) for anaemia.

Na HCO3 (acidosis)

Diuetics, loop and thiazide(oedema) and restrict fluid and sodium intake

Phosphate binders, vitamin D, cincalcet, for secondary hyperparathyroidism. Can do parathyroidectomy

Question 8

What are the methods of RRT?

Answer 8

Transplant
Peritoneal dialysis
Haemodialysis

Question 9

What is diagnostic criteria for CKD

Answer 9

eGFR < 60 for >3 months with marker of kidney damage e.g. protein/albuminuria, electrolyte abnormalities, structural abnormalities

Question 10

Which patients should get a renal US?

Answer 10

Accelerated progression of CKD

Visible haematuria

Persistent non-visible haematuria on urine dipstick

Recurrent urinary tract infection symptoms

Family history of ADPKD once aged >20 yrs

eGFR < 30

Question 11

Which patients (e.g. which underlying disease) will not give bilateral small kidneys?

Answer 11

• autosomal dominant polycystic kidney disease
• diabetic nephropathy
• amyloidosis
HIV-associated nephropathy

Question 12

What are complications of haemodialysis

Answer 12

• Dialysis disequilibrium syndrome
		○ Caused by cerebral oedema
	• Sepsis
	• DIC
Fluid overload

Question 13

What are complications of peritoneal dialysis

Answer 13

peritonitis: staph epidermidis most common

Question 14

What are complications of kidney transplant?

Answer 14

Hyperacute rejection (type II hypersensitivity)

Acute graft failure

Chronic graft failure