CKD

Question 1

How common is CKD?

Answer 1

-Common, often co-exists with other conditions
-Incidence increases with age

Question 2

What causes CKD?

Answer 2

-Often associated with old age, DM, HTN, obesity, CVD
-Glomerulonephritis
-Infective, obstructive and reflux nephropathies
-FH of stage 5 CKD / hereditary kidney disease eg polycystic
-Hypercalcaemia
-SLE
-Neoplasms
-Myeloma

Question 3

What risk factors are there for CKD?

Answer 3

-CVD
-Proteinuria
-AKI
-HTN
-DM
-Smoking
-African / Asian ethnicity
-Chronic NSAID use
-Untreated urinary outflow tract obstruction

Question 4

How does CKD present?

Answer 4

-Often asymptomatic and unrecognised so therefore diagnosed at an advanced stage
-In severe CKD:
–Anorexia
–Nausea
–Vomiting
–Fatigue
–Weakness
–Pruritus
–Lethargy
–Peripheral oedema
–Muscle cramps
–Polyuria / nocturia

Question 5

What signs might a CKD patient show on examination?

Answer 5

-Examination may reveal underlying cause or complications
-Increased skin pigmentation / excoriation
-Pallor
-HTN
-Postural hypotension
-Peripheral oedema
-LVH
-PVD
-Pleural effusions
-Peripheral neuropathy

Question 6

What other conditions might present similarly?

Answer 6

-AKI

Question 7

How would you investigate this patient?

Answer 7

-eGFR
-Plasma glucose (undiagnosed / uncontrolled diabetes)
-Serum Na+ (low), K+ (high), bicarb (low), albumin (low), PO4 (high)
-PTH (progressive rise as renal function declines)
-Cholesterol and triglycerides (usually high)
-FBC (normocytic anaemia)
-ACR
-ECG
-Renal USS, CT, MRI, biopsy

Question 8

What treatment would you offer to a patient with CKD?

Answer 8

-Spectrum of disease
-Monitor eGFR and BP
-Lifestyle advice
-Optimise glucose control
-Annual CV risk factor assessment - ?statin, anticoags, anti platelets