chronic renal disease

Question 1

what is the definition of chronic kidney disease?

Answer 1

a reduction in kidney function, structural damage or both, present for more than 3 months with associated health implications

Question 2

how do you diagnose chronic kidney disease?

Answer 2

the ass:
- Transplant
- Histological abnormalities detected on kidney biopsy
- Electrolyte abnormalities due to tubular disorders

• ACR (urinary albumin:creatinine ratio)greater than 3 mg/mmol
• Sediment abnormalities in the urine (haematuria/ casts)
• Structural abnormalities detected by imaging

and/or persistent reduction in renal function shown by eGFR of < 60ml/min/1.73m2

Question 3

what is accelerated progression of CKD?

Answer 3

persistent decrease in eGFR of 25%+ and a change in CKD category within a year
or
persistent decrease in eGFR of 15ml/min in a year

Question 4

what are the main causes of CKD?

Answer 4

diabetes
hypertension
glomerular disease
PCKD

Question 5

what are causes of obstructive uropathy?

Answer 5

renal calculi
prostate- malignancy, prostatitis, abscess
bladder- malignancy, chronic cystitis with bladder wall thickening
malignancy
structure / stenosis

Question 6

what is the biggest complication of CKD?

Answer 6

cardiovascular disease

Question 7

what are some other complications of CKD?

Answer 7

AKI, hypertension & dyslipidaemia, renal anaemia, renal mineral and bone disorder

Question 8

what causes renal mineral and bone disorder?

Answer 8

kidneys activate vit D so when damaged there is disturbed vitamin D, calcium, parathyroid hormone (PTH), and phosphate metabolism due to parathyroid having to take over in vit D activation. this causes abnormlaities in bone turnover and mineralisation.

Question 9

what causes renal mineral and bone disorder?

Answer 9

kidneys activate vit D so when damaged there is disturbed vitamin D, calcium, parathyroid hormone (PTH), and phosphate metabolism due to parathyroid having to take over in vit D activation. this causes abnormlaities in bone turnover and mineralisation.

Question 10

what is seen in renal mineral and bone disorder (symptoms and ion imbalances)?

Answer 10

bone pain, increased bone fragility, or extra skeletal calcification, such as in the skin or blood vessels

vit D deficiency, raised serum phosphate, low serum calcium and secondary or tertiary hyperparathyroidism in progressive CKD

Question 11

what is the management of CKD?

Answer 11

aceis / arbs if risk is low (eGFR less than 25% decreased)
statins
if bone problems- dietary and lifestyle advice,
salt reduction
alfadicol (active vit D)
phosphate binders