Chronic kidney disease (CKD)

Question 1

Name 3 causes

Answer 1

• Diabetes (commonest cause)
• Hypertension
• Age-related decline
• Glomerulonephritis
• Polycystic kidney disease
• Medications i.e. NSAIDS, PPIs and lithium

Question 2

Name 2 risk factors

Answer 2

• Older age
• Hypertension
• Diabetes
• Smoking
• Use of medications that affect the kidneys

Question 3

CKD is often asymptomatic and discovered in a routine testing, however, name 2 signs or symptoms that CKD may present with

Answer 3

• Pruritus
• Loss of appetite
• Nausea
• Oedema
• Muscle cramps
• Peripheral neuropathy
• Pallor

Question 4

Name 2 investigations involved in the diagnosis of CKD, and what are they looking for that may indicate CKD?

Answer 4

• U&E blood test - eGFR
• Urine dipstick albumin:creatinine ratio (proteinuria) and haematuria
• Renal ultrasound

Question 5

A proteinuria and eGFR of what is needed for a diagnosis of CKD?

Answer 5

eGFR <60 (on 2 separate occasions, 3 months apart) and proteinuria >3mg/mmol

Question 6

Name 2 complications of CDK

Answer 6

• Anaemia
• Renal bone disease
• Cardiovascular disease
• Peripheral neuropathy
• Dialysis related problems

Question 7

1) Name 1 way CKD progression can be slowed
2) Name 1 way of reducing the risk of complications
3) How can metabolic acidosis be treated?
4) How can anaemia be treated?
5) How can renal bone disease be treated?
6) How can end stage renal failure be treated?

Answer 7

1) Optimise diabetic control, optimise hypertensive control, treat glomerulonephritis
2) Exercise, maintain a healthy weight and stop smoking decreased dietary consumption of phosphate, sodium, potassium and water intake, atorvastatin 20mg for primary prevention of cardiovascular disease
3) Sodium bicarbonate
4) Iron (first) and erythropoietin supplementation (second)
5) Vitamin D supplementation
6) Dialysis or transplantation

Question 8

1) What are the 1st line antihypertensives for patients with CKD?
2) How can CKD cause anaemia?

Answer 8

1) ACE inhibitors
2) CKD damages kidney cells that produce erythropoietin, which stimulates the production of RBCs

Question 9

1) Name 2 features of renal bone disease, and what do they mean?
2) What is the pathophysiology that results in increased calcium absorption from bones in CKD?

Answer 9

1) Osteomalacia (softening of bones), osteoporosis (brittle bones), osteosclerosis (hardening of bones)
2) High serum phosphate due to decreased kidney excretion + low active vitD due to decreased kidney metabolisation into its active form. Active vitD important in calcium absorption from intestines therefore less calcium absorbed. Secondary hyperparathyroidism due to high phosphate and low calcium, this leads to increased parathyroid hormone release, which leads to increased osteoclast activation, which leads to the absorption of calcium from bone.

Question 10

1) How does the above pathophysiology lead to osteomalacia?
2) How does it lead to osteoporosis?
3) Name 2 aspects of the management of RBD
4) What drug can be given for the high phosphate?

Answer 10

1) Increased turnover of bones without adequate calcium supply
2) Osteoblasts increase bone production to match osteoclast activity but this new tissue is not properly mineralised due to low calcium
3) Low phosphate, active vitD supplementation, bisphosphonates for osteoporosis
4) Sevelamer

Question 11

Is CKD most commonly associated with enlarged or shrunken kidneys on US?

Answer 11

Shrunken

Question 12

Name 2 causes of CKD that would result in enlarged kidneys on US

Answer 12

• Diabetic nephropathy (in early stages)
• PCKD
• HIV associated nephropathy
• Amyloidosis