CKD

Question 1

A 48 year old man is attending his annual review at the nephrology clinic. He was diagnosed with type 1 diabetes as a teenager. His diabetes was poorly managed for many years.

Question 2

What is this patient most at risk of?

Answer 2

Diabetic nephropathy

Question 3

The patient is diagnosed with stage 5 CKD. Explain why diabetes leads to CKD?

Answer 3

• Scarring and fibrosis- damage to the nephrons
• Activation of RAAS
• Reduced blood flow to the kidneys

Question 4

Explain what you think has happened to the patient

Answer 4

Mineral bone disease
Calcium phosphate deposits

Question 5

The patient has mineral bone disease secondary to his CKD. Explain using this diagram how this occurs?

Answer 5

Impaired kidney, reduction in phosphate excretion
Stimulates PTH from parathyroid hormone
PTH is released to stimulate the kidneys to excrete more phosphate and to activate vitamin D
Increase in bone resorption
Phosphate increases in the plasma

Question 6

It is also noted in the patient’s blood test results that there is a low MCV. What could this indicate?

Answer 6

Microcytic anaemia- loss of EPO and iron.