Chronic kidney disease (CKD)

Question 1

What does chronic kidney disease describe?

Answer 1

Chronic reduction in kidney function sustained over 3 months
Tends to be permanent and progressive

Question 2

Presentation of CKD?

Answer 2

Most are asymptomatic
* Fatigue
* Pallor
* Foamy urine (proteinuria)
* Nausea
* Loss of appetite
* Puritus (itching)
* Oedema
* Hypertension
* Peripheral neuropathy

Question 3

Investigations for CKD?

Answer 3

eGFR-based on serum creatinine, age and gender- estimates the rate at which fluid is filtered from the blood into bowman’s capsule

Proteinuria- quantified with urine albumin:creatinine ratio (ACR)

Haematuria- assesed with urine dipstick and microscopy
* Microscopic- when blood is identified on testing but not visible on inspection
* Macroscopic- visible blood in the urine

Renal ultrasound- helps identify obstructions or polystic kidney disease

Identify risk factors:
* Blood pressure (hypertension)
* HbA1c (diabetes)
* Lipid profile (hypercholesterolaemia)

Question 4

Classification of CKD?

Answer 4

Diagnosis can be made whrn results are consistent over 3 months of either:
* eGFR- below 60ml/min/1.73m2
* Urine albumin:creatinine ratio (ACR)- above 3mg/mmol

G score based on eGFR. A score based on albumin:creatinine ratio

G1= eGFR over 90
G5= eGFR under 15

A1= under 3mg/mmol
A3= above 30mg/mmol

= bigger the score= worse the disease

Question 5

Accelerated progression of CKD is defined as?

Answer 5

Sustained decline in the eGFR within 1 year of either 25% or 15mL/min/1.73m2

Question 6

Kidney failure risk equation?

Answer 6

Used to estimate the 5 year risk of kidney failure requiring dialysis
If over 5%- suggest referral to a renal specialist

Question 7

Meds that can help CKD progression?

Answer 7

• ACE inhibitors (or ARBs)
• SGLT-2 inhibitors- dapagliflozin- offered to patients with diabetes plus a urine ACR above 30mg/mmol

Atorvostatin 20mg for primary prevention of cardiovascular disease

Serum potatssium needs monitoring as CKD and ACE inhibitors can cause hyperkalaemia

Question 8

Med management of complications associated with CKD?

Answer 8

• Oral sodium bicarbonate- treat metabolic acidosis
• Iron and erythropoietin- treat anameia
• Vit D, low phosphate diet and phosphate binders- treat renal bone disease

Question 9

Renal bone disease cause, presentation and treatment?

Answer 9

Complication of CKD

Involves:
* High serum phosphate
* Low vit D activity (as kidneys metabolise vit D into its active form)
* Low serum calcium

Presents:
* Secondary hyperparathyroidism
* Osteomalacia
* Osteosclerosis
* Rugger jersey spine- sclerosis of both ends of each vetebral body (denser white) and osteomalacia in the centre of the vertebral body (less white)

Management:
* Low phosphate diet
* Phosphate binders
* Active forms of vit D- Calcitriol
* Ensuring adequate calcium intake

Question 10

How do ACEI/ARBs delay disease progression?

Answer 10

By dilating the efferent arteriole which will lower intraglomerular pressure, prevent loss of protein and protect the kidney in the long term

SGLT2- constrict the afferent arteriole

Question 11

QRISK score?

Answer 11

Predicts cardiovascular risk development over the next 10 years
20% or more = high risk of developing CVD