Chronic Kidney disease

Question 1

what is chronic kidney disease defined as

Answer 1

A GFR of lower than 60 for 3 months or more

Question 2

Classification of CKD according to GFR

Answer 2

G1 : normal GFR>90
G2 : GFR 60-89 
G3A : GFR 45-59
G3b : GFR 30-44
G4 : GFR 15-29
G5 : GFR <15 kidney failure

Question 3

Classification of CKD according to albumin levels

Answer 3

A1- normal albumin levels
A2- Microalbuminuria
A3- Macroalbuminuria

Question 4

what are the complications of CKD?

Answer 4

CRF HEALS
cardiovascular disease
renal osteodystrophy
fluid ( oedema )
hypertension
electrolyte imbalance
anemia
leg restlessness ( uremia )
sensory neuropathy ( uremia )

Question 5

why are CVD more common in CKD patients

Answer 5

due to salt and water retention which causes fluid overload, excess fluid causes volume over load and pressure overload on the heart

Question 6

What are the causes of anemia in CKD ?

Answer 6

Anemia of chronic disease
increased hepcidin levels
b12 deficiency
decreased erythropoietin production levels
bone marrow is put in uremic conditions

Question 7

how does renal osteodystrophy happen

Answer 7

in CKD vit D can no longer be activated in the kidneys, which leads to hypocalcaemia so the body tries to compensate for calcium loss by breaking down bones
causing osteodystrophy

Question 8

Bone resorption in the vertebrae is called

Answer 8

Rugger Jersey spine, where the bones are more likely to be fractured

Question 9

what is the main cause of mortality in CKD

Answer 9

cardiovascular disease

Question 10

What investigations would you order in CKD

Answer 10

eGFR, asses renal complications, creatinin , serum calcium, serum parathyroid hormone, ABG, iron studies , Urinalysis, albumin creatinine ratio

Question 11

What is the management of CKD

Answer 11

First lifestyle change, less proteins , less salt in the diet
avoid a sedentary lifestyle
first line treatment would be ACE inhibitors
if intolerant then Angiotensin II receptor agonist

Question 12

what to give an anemic patient with CKD

Answer 12

Intravenous iron to surpass the hepcidin pathway, give iron first then erythropoietin

Question 13

How to treat renal osteodystrophy

Answer 13

low phosphate diet,
phosphorus binders,
Sevelamer (non calcium binders)
vitamin D therapy

Question 14

what are the indications for dialysis in CKD

Answer 14

1: uremic symptoms,
2: fluid overload that is unresponsive to diuretics,
3: refractory hyperkalemia,
4: severe metabolic acidosis,
5: serum creatinine 10mg and urea 200mg

Question 15

what disease happens as a result of improper calcium metabolism and vit d activation in CKD

Answer 15

hyperparathyroidism

Question 16

what are examples of nephrotoxic drugs ?

Answer 16

IV radiocontrast media
NSAIDs
aminoglycosides , ASA

Question 17

what are the measurements taken for renoprotection ?

Answer 17

control blood pressure
reduce or control proteinuria
reduce cardiovascular risk

Question 18

what is the blood pressure target for different age groups of patients with CKD ?

Answer 18

18-65 yo = 130-140
65-79 yo = 130-139
above 80 years = 130-139

generally speaking from 130-140

Question 19

what drugs should be used in patients with diabetic kidney disease ?

Answer 19

RAS blockers along with SGLT2 for glycemic control

Question 20

what is the best drug option for blood pressure control in CKD patients who have proteinuria ?

Answer 20

ACE inhibitors or ARBs

Question 21

what is the target HbA1c in CKD patients ?

Answer 21

below 7

Question 22

what is the association between hepcidin and EPO ?

Answer 22

increased EPO levels are associated with reduced hepcidin levels

Question 23

what is the normal albumin excretion rate in urine ?

Answer 23

2 mg/dl

Question 24

What is the most important precaution for CKD patient hand veins

Answer 24

Don’t insert a cannula or take blood samples from non-dominant arm of CKD patient to save this arm for making arteriovenous fistula