Chronic Kidney Disease

Question 1

What is chronic kidney disease?

Answer 1

The progressive and irreversible loss of renal function, shrinking of kidney and replacement of healthy tissue with scar tissue

Question 2

In which populations is CKD more common?

Answer 2

Th elderly, certain ethnic minorities, people with other morbities, socially deprived

Question 3

What are the two most common causes of CKD?

Answer 3

Diabetes and hypertension

Question 4

What are the most important things to measure when investigating CKD?

Answer 4

Blood pressure and proteinuria

Question 5

What investigations can be used to diagnose CKD?

Answer 5

Blood tests, ultrasound (size and obstruction?), kidney biopsy, other scans looking for specific causes

Question 6

What are the modifiable risk factors for CKD?

Answer 6

Lifestyle, smoking, obesity and lack of exercise

Question 7

What are non-modifiable risk factors which we can control to delay progression of CKD?

Answer 7

Proteinuria- give ACE inhibitors/angiotensin receptor blockers
Hypertension- give anti-hypertensives
Diabetes- ensure well managed

Question 8

Within what target ranges do we want to keep the blood pressure of CKD patients with and without diabetes?

Answer 8

CKD without diabetes: 120-140/90

CKD with diabetes: 120-129/80

Question 9

Why is it that patients with CKD have nocturia?

Answer 9

Reduced concentrating ability and reduced response to ADH

Question 10

With regards to water handling in CKD, why are patients at such high risk of fluid overload?

Answer 10

Reduced maximum ability to excrete urine

Question 11

What are some of the complications associated with CKD?

Answer 11

Hyperkalaemia, bone mineral disease, anaemia, hypertension, metabolic acidosis, altered drug metabolism and accumulation of waste products

Question 12

How would you treat the hyperkalaemia associated with CKD?

Answer 12

Maintain good urine output

May need to : stop ACE inhibitors or other drugs increasing K+ levels, altering diet to low potassium

Question 13

How do you treat the acidosis associated with CKD?

Answer 13

Oral NaHCO3 tablets

Question 14

Why is it beneficial to treat anaemia with CKD patients?

Answer 14

Slows progression of renal disease, reduces mortality and helps improve patients quality of life (increased exercise capacity and cognitive function)

Question 15

How would you go about treating anaemia associated with CKD?

Answer 15

First check iron stores and if low replace, then re-check Haemoglobin. If Haemoglobin low give erythropoietin stimulating agent ESA

Question 16

Why does bone mineral disease occur with CKD?

Answer 16

Less less activation of vitamin D, so less calcium absorption in gut, low calcium plasma stimulates PTH so increase bone reabsorption.
Less excretion of phosphate, increased phosphate levels also stimulate parathyroid

Question 17

How would you manage CKD-BMD?

Answer 17

Reduce phosphate intake, give phosphate binders and vitamin D (may need to be already activated)

Question 18

Why is it that lots of drugs require dose alteration in CKD?

Answer 18

Reduced metabolism and/or elimination by kidney

Question 19

What symptoms does the accumulation of waste products give rise to in CKD?

Answer 19

Reduced appetite, nausea, vomiting pruritus

Question 20

How is end stage renal failure defined?

Answer 20

Death is likely without renal replacement therapy, eGFR <15 mls/min

Question 21

What are the different types of renal replacement therapy?

Answer 21

Hemodialysis, peritoneal dialysis, transplant