CKD

Question 1

What is the definition of chronic kidney disease?

Answer 1

permanent loss of renal function (eGFR <60mL/min/1.73m2) OR irreversible renal injury > 3 months duration

Question 2

What is the definition of end-stage renal disease?

Answer 2

permanent loss of renal function that requires renal replacement therapy (GFR <15mL/min)

Question 3

What are the risk factors for CKD?

Answer 3

• diabetes
• hypertension
• obesity
• > 60 years of age
• substance use
• acute kidney injury
• family history of CKD
• african american or hispanic descent

Question 4

What is the pathophysiology of CKD?

Answer 4

• progressive nephron loss
• structural damage
• impaired kidney function

Question 5

What are the complications of CKD?

Answer 5

• sodium retention & volume overload
• hyperkalemia
• metabolic acidosis -> give bicarb
• increased phosphate & PTH
• decreased calcium & calcitriol
• anemia -> give erythropoietin
• renal osteodystrophy
• pericarditis -> correct uremia
• end-stage renal disease
• vascular or peritoneal catheter associated infections
• transplant related problems

Question 6

What are the clinical features of CKD?

Answer 6

asymptomatic until late

• neurologic signs -> lethargy, somnolence, confusion, neuromuscular irritability, & ASTERIXIS
• cardiovascular signs -> hypertension, CHF, & pericarditis
• GI signs -> anorexia, nausea, vomiting, & a metallic taste
• metabolic signs -> fatigue, pruritus, sleep disturbances, & bone pain (due to secondary hyperparathyroidism)

Question 7

What are the diagnostic tools used in CKD?

Answer 7

• Urinalysis -> PROTEINURIA
• eGFR
• CBC -> anemia & thrombocytopenia
• electrolytes -> hyperkalemia & hypernatremia
• renal US -> check kidney size & rule out obstruction
• biopsy -> to determine etiology

Question 8

How is chronic kidney disease managed?

Answer 8

• low protein diet & restriction of potassium, phosphate, & magnesium intake
• supplementation of Ca & vit D
• Bicarbonate if there’s acidosis
• ACEI/ARB in case of proteinuria
• avoid nephrotoxic substances
• vaccinations
• BP <130/80mmHg
• glycemic control (SGLT2)
• EPO injections of Hb <10
• correct volume overload

Question 9

What are the indications for dialysis?

Answer 9

AEIOU

• acidosis
• electrolyte disturbance -> severe persistent hyperkalemia
• intoxications -> methanol, ethylene glycol, lithium, aspirin
• overload
• uremia -> based on clinical presentation only (pericarditis & encephalopathy)