CKD

Question 1

Definition of CKD

Answer 1

GFR < 60 that is present for 3 months with or without kidney damage or evidence of kidney damage with reduced GFR that is present for > 3 months

Question 2

Evidence of kidney damage

Answer 2

Albuminuria, heamatruia, structural abnormalities, pathological abnormalities (e.g. renal biopsy)

Question 3

Risk factors for CKD

Answer 3

DM, HTN, established CVD, obesity, smoking, > 60 yrs old, ATSI, history of AKI, family history of kidney failure

Question 4

What is involved in kidney health check

Answer 4

eGFR, ACR, BP check

Question 5

Normal urine ACR

Answer 5

Male < 2.5, female < 3.5

Question 6

Microalbuminuria on ACR

Answer 6

Male 2.5-25, female 3.5-35

Question 7

Macroalbuminuria on ACR

Answer 7

Male > 25, female > 35

Question 8

Recommended salt intake for CKD

Answer 8

< 6g per day

Question 9

High calorie sweetened carbonated beverages and CKD

Answer 9

Avoid at all costs

Question 10

Recommended physical activity for CKD

Answer 10

150-300 minutes moderate intensity physical activity or 75-150 mins of vigorous activity

Question 11

Alcohol intake and CKD

Answer 11

< 2SD daily and no more than 4 SD on

Question 12

BP target for CKD

Answer 12

130/80

Question 13

Lipids and CKD

Answer 13

Uses statin or statin/ezetimibe in people over 50 with any stage of CKD, or in people <50yrs in the presence of one or more of coronary disease, previous ischeamic stroke, diabetes or CVD risk > 15%

Question 14

Triple whammy drugs

Answer 14

ACE (or ARB), diuretic and NSAID or COX2 inhibitor

Question 15

What is the acceptable cut off for reduction in GFR following starting ACE or ARB

Answer 15

25% within 2 months

Question 16

Most common causes of CKD in Australia

Answer 16

Diabetes, glomerulonephritis, HTN, polycystic kidney disease

Question 17

How often should a kidney health check be done for those with risk factors?

Answer 17

Every 1-2 yrs

Question 18

ATSI CKD detection recommendation

Answer 18

18-29 screen for risk factors. > 30 yrs every 2 yrs. If urine ACR positive repeat twice over 3 months (preferably first morning void), if GFR < 60 repeat within 7 days

Question 19

Clinical situations where GFR may be unreliable

Answer 19

AKI, dialysis, recent consumption of cooker meat, vegetarian, high protein diet, extremes of body size, paraplegia or amputees (overestimate GFR), high muscle mass, children, severe liver disease, drugs interfering with excretion, pregnancy

Question 20

What is the preferred test for pregnant women?

Answer 20

Serum creatinine

Question 21

Factors known to increase urine albumin excretion?

Answer 21

UTI, high dietary protein, febrile illness, heavy exercise, menstruation, genital discharge

Question 22

Diagnostic tests for CKD that are always indicated

Answer 22

Renal ultrasound, eGFR, FBC, CRP, ESR, urine ACR, fasting lipids and glucose, urine microscopy for dysmorphic red cells, red cell casts or crystals

Question 23

What CVD risk is someone with moderate or severe CKD with persistent albuminuria?

Answer 23

Highest risk > 15%

Question 24

How common is CKD in patients with T2 DM

Answer 24

1 in 2

Question 25

When should you reduce metformin in patient with CKD?

Answer 25

eGFR 30-60

Question 26

When is metformin contraindicated in CKD?

Answer 26

eGFR < 30

Question 27

When are SGLT2 inhibitors contraindicated in CKD?

Answer 27

eGFR < 45

Question 28

At what eGFR do sulphonylureas need dose reduction?

Answer 28

eGFR < 30

Question 29

At what eGFR do GLP-1 receptor agonists need dose adjustment?

Answer 29

eGFR <30

Question 30

Commonly prescribed drugs that can adversely affect kidney function?

Answer 30

Amino glycosides, calcineurin inhibitors (tacrolimus) gadolinium, lithium, NSAIDs and COX 2 inhibitors, contrast

Question 31

When is a referral to nephrologist recommended?

Answer 31

eGFR< 30, persistent significant albuminuria, sustained decrease in eGFR of 25% or more within 12 months or a sustained decrease in eGFR of 15ml/min per year, CKD with HTN that is hard to get to target depsite at least anti-hypertensive agents

Question 32

Management of acidosis in CKD

Answer 32

Sodium bicarbonate - titrate to keep the HC03 above 22

Question 33

Risk factors for urological malignancy

Answer 33

Male, > age 40yrs, history of macroscopic haematuria, smoking, pelvic irritation, exposure to occupation chemicals - dyes or cyclophosphamide

Question 34

Hyperkalaemia in CKD

Answer 34

Above 6.0 mmmol/s is of concern and should be managed - low K diet, correct metabolic acidosis, potassium wasting diuretics (thiazides), avoid salt substitutes (may be high in K), resonium, cease ACEi, ARB, spironolactone if persistently above 6

Question 35

What level of K+ is considered a medical emergency in patients with CKD

Answer 35

6.5mmol/s

Question 36

What can lead to low calcium in CKD patients?

Answer 36

Low vitamin D = less vitamin D dependant calcium uptake from the GIT

Question 37

What causes phosphate to increase?

Answer 37

As kidney function decreases the renal clearance of phosphate is reduced

Question 38

What stimulates the increased production of PTH in CKD patients?

Answer 38

High phosphate, low calcium and low vitamin D levels –> increased bone resorption and and release of mineral from the bone

Question 39

What is the cause of uraemia?

Answer 39

Breakdown products of protein metabolism

Question 40

What are the symptoms of uraemia?

Answer 40

Anorexia, nausea, vomiting, lethargy, confusion (encephalopathy), muscle twitching, pericarditis, fluid overload, convulsions, coma