CKD

Question 1

Using the QRISK calculation, what would NICE says to offer someone NICE if >10% risk of CVD within 10 years

Answer 1

atorvostatin

Question 2

If a pt’s has stage 1 hypertension, under what circumstances should you offer then drug treatment?

Answer 2

any of the following are present:
- target organ damage
- CVD
- renal disease
- diabetes
- 10yr CVD risk >= to 10%

Question 3

What are the BP readings that mark stage 1 hypertension and stage 2 hypertension?

Answer 3

1: ABPM or HBPM is 135/85-149/94 mmHg
2: ABPM or HBPM is 150/90 + mmHg

Question 4

Proteinuria is a marker of _____ dysfunction

Answer 4

glomerular

Question 5

Name some drugs/interventions which improve proteinuria. (4)

Answer 5

• ACEi or ARB
• SGLT-2 inhibitors
• salt restriction (to normal recommended levels

Question 6

A pt is on amlodipine for hypertension management. He develops proteinurea, so is started on an ACEi. How and why may his treatment need to be adjusted?

Answer 6

stop amplodipine if BP drops too much

ACEi is an antihypertensive drug

Question 7

NICE guidelines in CKD:
“Consider prescribing aspirin in people with a high risk of ____ or ____

There is limited evidence of benefit even in people with multiple risk factors and there is a risk of harm

As such, we tend to avoid aspirin for primary prevention.

Answer 7

stroke or myocardial infarction

Question 8

A pt with CKD is prescribed trimethoprim for a UTI. This invalidates the GFR calculators.

Why is this, and do you think his GFR has in fact changed?

Answer 8

GFR probably hasn’t changed (but impossible to say without formally measuring it)

Trimethoprim inhibits the active secretion of creatinine so the equation to calculate GFR is now invalid.

Trimethoprim breaks the link between creatinine and GFR

Question 9

A pt has a CKD. He takes an ACEi to treat his hypertension as well as his proteinurea. He recently developed a UTI which the GP prescribed an antibiotic for. The UTI has now progressed and he started taking ibuprofen to help with the loin pain. Now he is diagnosed with pyelonephritis and his GFR has also dropped substantially.

How could ibuprofen and ACEi be contributing to his worsening GFR?

Answer 9

Ibuprofen
Inhibits PG synthesis and reduces renal blood flow

ACEi
Reduces perfusion pressure in glomerulus, exacerbated by sepsis

Question 10

There are two things to consider when prescribing for a patient with reduced renal function:

Might the drug damage the kidney and hence worsen the kidney injury
(eg ibuprofen)

2) Is the drug eliminated by the kidney, and hence will it accumulate in the blood if kidney function is impaired, and hence lead to side effects?
(eg morphine, metformin)

Answer 10

revise / remember