Chronic Kidney Disease (CKD)

Question 1

what is chronic kidney disease?

Answer 1

gradual loss of kidney function

Question 2

causes of CKD

Answer 2

• vascular= hypertension, reno-vascular, RAS, FMD
• GN= IgA, minimal change, FSGS, MPGN, membranous, HSP
• systemic= diabetes, myeloma, amyloidosis, vasculitis, SLE
• genetic= ADPKD, Alports, medullary sponge kidney, tubulopathies
• obstructive= PUJ, malignancy, RPF

Question 3

stages of CKD

Answer 3

G1-G5

Question 4

stage G1 CKD

Answer 4

> 90ml/min/1.73m2

normal kidney function but urine findings or structural abnormalities or genetic trait point to kidney disease

Question 5

stage G2 CKD

Answer 5

60-89ml/min/1.73m2

mildly reduced kidney function but urine findings or structural abnormalities or genetic trait point to kidney disease

Question 6

stage G3a CKD

Answer 6

45-59ml/min/1.73m2

moderately reduced kidney function

Question 7

stage G3b CKD

Answer 7

30-44ml/min/1.73m2

moderately reduced kidney function

Question 8

stage G4 CKD

Answer 8

15-29ml/min/1.73m2

severely reduced kidney function

Question 9

stage G5 CKD

Answer 9

<15ml/min/1.73m2

established renal failure

Question 10

presentation of CKD

Answer 10

anaemia
weight loss
uraemia= lemon yellow, uraemic frost, encephalopathy flop, confusion, pericardial effusion, Kussmaul’s breathing, N&V, restless
pain and psychiatric problems due to diet restrictions

Question 11

diagnosis of CKD

Answer 11

2 samples 90 days apart with eGFR low

Question 12

classification of ACR (albumin creatinine ratio)

Answer 12

A1-A3

Question 13

ACR A1

Answer 13

<3

Question 14

ACR A2

Answer 14

3-30

Question 15

ACR A3

Answer 15

> 30

Question 16

what is accelerated progression of CKD?

Answer 16

sustained decrease in GFR of 25% or more and a change in GFR category within 12 months or a sustained decrease in GFR of 15ml/min/1.73m2 per year

Question 17

management of CKD

Answer 17

keep systolic BP low <140/90
prevent CVD with atorvastatin
RRT= dialysis or transplantation

Question 18

three extra-renal consequences of CKD

Answer 18

1. CVD
2. CKD-MBD
3. renal anaemia

Question 19

management of renal CVD

Answer 19

smoking cessation
exercise
control hypertension
limit salt
statins and aspirin

Question 20

CKD-MBD

Answer 20

secondary and tertiary HPT
vascular calcification
bone fractures

Question 21

management of CKD-MBD

Answer 21

phosphate, Na+, K+ and fluid restriction
alfacalcidol (active vitamin D)
phosphate binders
calcimimetic e.g. cinacalcet

Question 22

examples of phosphate binders

Answer 22

calcium-based e.g. adcal/phoslo/osvaren
aluminium e.g. alucaps
non-calcium based e.g. lanthanum/ sevelamer

Question 23

target Hb in renal anaemia

Answer 23

100-120g/L

Question 24

what to exclude in renal anaemia?

Answer 24

other causes such as B12 and folate deficiency, check ferritin, iron and TSats

Question 25

management of renal anaemia

Answer 25

iron therapy

erythropoiesis stimulating agents (ESA)

Question 26

when are ESA used?

Answer 26

Hb <100-110g/dl

Question 27

iron therapy options

Answer 27

oral (ferinject- ferric carboxymaltose or venofer- iron sucrose)
IV if oral fails