Chronic Kidney Disease (CKD)

Question 1

Define Chronic Kidney Disease (Chronic Renal Failure)

Answer 1

CKD is either;

• Kidney damage >=3 months based on findings of abnormal structure or function
• GFR <60mL/min/1.73m² for >3 months with or without evidence of kidney damage

Question 2

What are the classifications of stages of CKD?

Answer 2

1. GFR >90 - normal or inc. GFR with other evidence of renal damage
2. GFR 60-89, slight dec. GFR with other evidence of renal damage
3. A, GFR 45-59, moderate dev. GFR with or without…

B, GFR 30-44, moderate dev. GFR with or without…

4. GFR 15-29, severe dec. GFR with or without…
5. GFR <15, established renal failure

Question 3

At what stage do symptoms usually start to occur in CKD?

Answer 3

Stage 4 when GFR 15-29, severe dec. GFR with or without evidence of renal damage

Question 4

Define End Stage Renal Failure (ESRF)

Answer 4

Stage 5 (when GFR <15, established renal failure)

OR the need for replacement therapy occurs (dialysis or transplant)

Question 5

What are the causes of CKD?

Answer 5

1. Diabetes
2. GN (IgA nephropathy)
3. Unknown
4. Hypertension or renovascular disease
5. Pyelonephritis or reflux nephropathy

Question 6

How does CKD present?

Answer 6

• Asymptomatic
• Lethargy, myalgia, Inc JVP
• Hands
  
  • Pallor (anaemia)
  • Koilonychia (iron deficient anaemia)
  • Low cap refill
  • Scars (blood taking & fistulas)
• Skin
  
  • Pruritis (massive cause of mobidity)
  • Skin pigmentation
  • Easy bruising
• GFR <5 (BOUNCE)
  
  • Breathlessness
  • Oedema
  • Uraemic frost
  • Neuropathy
  • Chest pain
  • Encephalopathy

Question 7

What investigations would you perform for CKD?

Answer 7

1. Bloods
   
   • Hb (low, normocytic normochromic)
   • U&Es - high urea & creatinine
   • Glucose (DM)
   • Low Ca2+ & High PO43-
2. ​Urine
   
   • MC&S, dipstick, 24h urinary protein
3. Renal US (size usually small)
4. CXR: Cardiomegaly, pleural/pericardial effusions or pulmonary oedema
5. Renal biopsy
   
   • If cause unclear or kidneys are normal size

Question 8

Outline the management for CKD

Answer 8

• Treat reversible cause: relieve obstruction, stop nephrotoxic drugs, deal with inc Ca²⁺ and CV risk
• Lifestyle: Exercise/ weight, diet (watch Na+, protein)
• Treat hypertension: target <140/85
• CV disease: statins, aspirin
• Anaemia: exclude IDA & chronic infection; consider erythropoietin
• Renal bone disease
• Oedema: loop diuretics, restrict fluid/ Na⁺
• Restless legs
• Dialysis/ transplantation