CKD

Question 1

What is CKD

Answer 1

Chronic Kidney Disease - chronic reduction in kidney function which tends to be permanent and progressive over a period of three months .

Question 2

What are the TWO MAIN causes of CKD

Answer 2

Diabetes
Hypertension

Question 3

What is the link between diabetes and CKD

Answer 3

1- excess glucose in blood sticks to proteins ( NON- ENZYMATIC GLYCATION)
2- efferent arterioles become stiff and narrow- HYALINE ARTERIOSCLEROSIS
3- increased pressure in glomeruli
4- hyperfiltration
5- Response to high pressure state - supportive mesangial cells secrete structural matrix expanding size of glomerulus
6- Over years this dimishes nephron ability to filter blood leading to CKD

Question 4

What can a decreased infiltration rate lead in relation to urea

Answer 4

Ureamia -urea in blood

Question 5

What can ureamia cause

Answer 5

-N/V
- Encephalopathy
- Pericarditis
- Bleeding
-Uremic frost

Question 6

Role of kidneys in regulation of Calcium

Answer 6

• Normally kidneys activate vit d which helps to increase absorption of Ca from diet
• In CKD this is disrupted leading to hypocalcaemia
• can lead to secondary hyperparathyroidism

Question 7

Risk factors for CKD

Answer 7

Older age
Hypertension
Afro-carribean
Diabetes
Smoking
Use of medications that affect the kidneys

Question 8

Pathophysiology of HT and CKD

Answer 8

• Walls of arteries begin to thicken in order to withstand pressure- but causes a narrow lumen
• less o2 delivery, ischemic injury in nephron glomerulus
• macrophages and fat laden macrophages called foam cells slip into the damaged glomerulus
• growth factors are secreted TGF-B1
• Cause mesangial cells to regress back to mesangioblasts
• these secrete extracellular structural matrix - leads to glomerulosclerosis + diminshes nephrons ability to filter blood

Question 9

Signs of CKD

Answer 9

• HT
  -Fluid Overload
• Uraemic sallow
• Pallor - anaemia due to decreased EPO

Question 10

Failing GFR lead to what?

Answer 10

Renin secretion by kidneys > HT

Question 11

Symptoms of CKD

Answer 11

• aSYMPTOMATIC early on
• Lethargy
• Pruritus
• Muscle Cramps
  -Nausea
• Frothy Urine
• diabetic nephropathy

Question 12

Investigations for CKD

Answer 12

Urine Dip/ urinalysis- proteinuria + haematuria + glycosuria
ACR
FBC- normocytic anaemia secondary to reduced EPO
Bone profile and PTH
Renal US
ECG

Question 13

Describe the G score system

Answer 13

G1 = eGFR >90
G2 = eGFR 60-89
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15 (known as “end-stage renal failure”)

Question 14

Describe the A score system

Answer 14

The A score is based on the albumin:creatinine ratio:

A1 = < 3mg/mmol
A2 = 3 – 30mg/mmol
A3 = > 30mg/mmol

Question 15

What would give you a definitive diagnosis of CKD

Answer 15

eGFR of < 60 or proteinuria
eGFR < 90ml/min/1.73m2 + signs of renal damage
Albuminuria > 30mg/24hrs

Question 16

When would you refer to a specialist

Answer 16

-eGFR < 30
-ACR ≥ 70 mg/mmol
-Accelerated progression defined as a decrease in eGFR of 15 or 25% or 15 ml/min in 1 year
-Uncontrolled hypertension despite ≥ 4 antihypertensives

Question 17

What would slow the progression of the disease

Answer 17

Optimise diabetic control
Optimise hypertensive control
Treat glomerulonephritis

Question 18

What would reduce the risk of complications in CKD

Answer 18

Exercise, maintain a healthy weight and stop smoking
Special dietary advice about phosphate, sodium, potassium and water intake
Offer atorvastatin 20mg for primary prevention of cardiovascular disease

Question 19

How would you treat complications in CKD

Answer 19

Oral sodium bicarbonate to treat metabolic acidosis
Iron supplementation and erythropoietin to treat anaemia
Vitamin D to treat renal bone disease
Dialysis in end stage renal failure
Renal transplant in end stage renal failure

Question 20

Complications of CKD

Answer 20

Cardio
- CVD
- HT
-Hypercholestrolaemia

MSK
- CKD- metabolic bone disease

Endo
- secondary hyperparathyroidism
- diabetes

Oedema

Question 21

What type of anaemia does chronic kidney disease most commonly cause?

Answer 21

Normocytic

Question 22

What type of anaemia does chronic kidney disease most commonly cause?

Answer 22

Diffuse proliferation glomerulonephritis

Question 23

A patient with a history of chronic kidney disease dies following a myocardial infarction. What does his renal biopsy demonstrate?

Answer 23

Diabetic nephropathy

Question 24

A patient with a history of rheumatoid arthritis develops chronic kidney disease. A renal biopsy is taken:

Answer 24

Amyloidosis