Chronic Kidney Disease (CKD)

Question 1

What is the CKD classification based on GFR?

Answer 1

Stage I: GFR > 90ml/min with risk factorsStage II: GFR 60-89 mL/minStage III: GFR 30-59mL/minStage IV: GFR 15-29mL/minStage V: GFR

Question 2

What is the CKD classification based on GFR?

Answer 2

Stage I: GFR > 90ml/min with risk factorsStage II: GFR 60-89 mL/minStage III: GFR 30-59mL/minStage IV: GFR 15-29mL/minStage V: GFR

Question 3

DDx of CKD

Answer 3

Rule out:- reversible conditions like prolonged AKI - falsely elevated serum creatinine such as drugs like trimethoprim

Question 4

Management of CKD

Answer 4

• Diagnose comorbid conditions and treat by nephrologist of anamia, HTN, metabolic bone dsiease- Prevent progression of CKD with treatment of HTN, DM, proteinuria, acidosis and bone/mineral disease

Question 5

Define End Stage Renal Disease (ESRD).

Answer 5

This is the final stage of CKD.ESRD represents a progression of CKD to a GFR

Question 6

What are the major causes of ESRD?

Answer 6

Diabetes HTN

Question 7

Management of ESRD

Answer 7

1. Dialysis (haemodialysis or peritoneal dialysis)2. HTN: volume management and pharmacotherapy3. Anaemia: ESA, iron supplementation, reduce phlebotomy4. Renal osteodystrophy: control phosphorous, calcium and PTH5. Vascular access creation and preservation6. Appropriate dosing of medication to a GFR

Question 8

If haemodialysis is chosen for ESRD management, what needs to be prepared?

Answer 8

AV fistula 3 months ahead

Question 9

If peritoneal dialysis is chosen for management, what needs to be prepared?

Answer 9

Tenchkoff catheter is placed app 2 weeks prior to dialysis

Question 10

At which stage of CKD is there progressive worsening?

Answer 10

Stage III: 30-59 mL/min GFR is the stage that needs to prepare for renal replacement therapy (transplant or dialysis), as it is only a matter of time before they reach ESRD

Question 11

At which stage of CKD is there progressive worsening?

Answer 11

Stage III: 30-59 mL/min GFR is the stage that needs to prepare for renal replacement therapy (transplant or dialysis), as it is only a matter of time before they reach ESRD

Question 12

T/F - choosing to dialyse is based on GFR

Answer 12

False! Choosing to dialyse a patient is based on SYMPTOMS.AEIOU acronym:-Acidemia (metabolic acidosis)- Electrolyte abnormalities with ECG changes (usually hyperkalaemia)- Intoxication ( SLIME: Salicylates, Lithium, Ispropanol, Methanol, Ethylene glycol)- Overload of fluid unresponsive to diuretics- Uremic (too much nitrogenous waste) Sx: pericarditis, ecephalopathy or altered mental state, other neuro Sx, severe bleeding diathesis esp in GI)

Question 13

T/F - choosing to dialyse is based on GFR

Answer 13

False! Choosing to dialyse a patient is based on SYMPTOMS.AEIOU acronym:-Acidemia (metabolic acidosis)- Electrolyte abnormalities with ECG changes (usually hyperkalaemia)- Intoxication ( SLIME: Salicylates, Lithium, Ispropanol, Methanol, Ethylene glycol)- Overload of fluid unresponsive to diuretics- Uremic (too much nitrogenous waste) Sx: pericarditis, ecephalopathy or altered mental state, other neuro Sx, severe bleeding diathesis esp in GI)

Question 14

___Ca and ____PO4 in CKD

Answer 14

Hypocalcaemia and Hyperphosphatemia