CKD

Question 1

Read some more in K&C about prevalence and staging of CKD - - -

Question 2

List causes (in book) pg 775 of CKD under the following headings -

Congenital and inherited diseases
Glomerular disease
Vascular disease
Tubulointerstitial disease
Urinary tract obstruction.

Question 3

Describe (from the book) the full progression of CKD

Inc the kidney nephrons, angiotensin 11 function
Proteinuria effect

Question 4

What few factors does the prognosis of CKD correlate with + summarise the general therapy aims which slow the rate of CKD progression

Answer 4

Factors affecting prognosis -
Hypertension
Proteinuria
Histology (degree of scarring in interstitium, but not changes of glomeruli)

Therapy is aimed at:
.Inhibiting angiotensin II
.Reducing proteinuria (with ACEi/ ARBs

Question 5

Describe why we get symptoms in CKD (referring to toxins - metabolic) and also refer to the accumulation of creatinine and urea … + when symptoms start to present

Answer 5

Early stages - fully asymptomatic, but later start to find symptoms

Symptoms thought to be as a result of the build of toxic metabolites (unknown, but thought to be nitrogen based).

Urea and creatinine are used as a surrogate for these metabolites as they are easy to measure, but we don’t know if they cause toxic themselves … (but correlation, increased creatinine with worsening condition)

Question 6

Symptoms of CKD

Answer 6

Nausea/ Vom
Cachexia
Convulsions/ Faintings
Anaemia - tiredness
Bone pain
Confusion
Pruritus
Oedema symtpoms
Parasthesia - polyneuropathy
Nocturne - polyuria

Amenorrhea women
ED men

Question 7

Remember that oliguria indicates more acute kidney injury, whereas in CKD tend to see polyuria etc after a while …

Question 8

Read book (777) for what to look for on examination - - specific to uraemia and genitalia and kidney

Question 9

List some investigations here, and go to book (777) and it explains what each is looking for specifically.

List 8 Here

Answer 9

Urinalysis
Urine microscopy
Urine biochemistry
Serum biochemistry
Haematology
Immunology
Radiological Investigation
Renal biopsy

Question 10

List/ describe a few ways in which normocytic anaemia can develope in someone with CKD

Answer 10

EPO deficiency

Increased blood loss - GI, occult, haemodialysis loss …

Bone marrow toxins

Increased RBC destruction - cells have short life in uraemia

ACEi ‘ s

Question 11

Describe in detail how we are managing anaemia In CKD with use of ESA’s

Answer 11

Erythropoiesis stimulating agents

Subcut/ IV
Start does 50U/Kg epoetin / day 3 times weekly
IV iron can be given prior.

Question 12

Go to book to learn more about ESA’s inc what we are trying to achieve with them, the effects etc . . .

Question 13

Go to the book to learn the target effects of treatment of anaemia in CKD

Question 14

Read in book (779) about the pathogenesis of CKD mineral bone disorder

Question 15

Can read how CKD can causes calciphylaxis, CVD, Skin disease, Gi comps, Metabolic abnormalities, Endo abnormalities and muscle dysfunciton

Question 16

What are the general measurements in the management of CKD

Answer 16

• Make diagnosis and treat modifiable causes
• Address CVD risk factors
• Avoid nephrotoxic drugs - examples??
• Follow up for those who may progress

Question 17

Correction of hyperkalaemia in CKD?

Answer 17

Dietary restriction of K

Stop drugs causing k Retention
Need to learn about emergency treatment of severe hyperkalaemia (pg168)

Question 18

Correction of acidosis?

Answer 18

Sodium bicarb supplements
(4.8g of Na+ and HCO3- a day)

Calcium carbonate can be used to

Question 19

Nephrotoxic drugs include?

Answer 19

Tetracyclines (except doxy maybe)
Ones excreted by kidneys (e.g. gentamicin)
NSAIDs
K sparing agents (spironolactone, amiloride)

Adjust - a biotic/ anti coats/ beta blockers/ insulin/ anti depressants/ analgesics.

Question 20

What are the 4 functions of RRT dialysis

Answer 20

Eliminating waste
Maintaining normal electrolyte concs
Preventing systemic acidosis
Maintaining a normal extracellular vol.

Question 21

Describe the basic principles of haemodialysis

Answer 21

Anticoagulated blood from patient is pumped around circuit into semiperm membrane and returned to circulation.

In Dialyser - pure diasylate flows in app direction close to blood. Solutes (small can diffuse down conc gradient)

Transmembrane pressure allows controlled fluid removal via ultrafiltration

4 hour sesh, 80L Blood done

Question 22

Learn in book 783, more about how to gain access to the blood circulation.

Question 23

What the aims of haemodialysis - - -5

Answer 23

Maintain euvolaemia - (if patient anuric and drinks 2L water - they gain weight - so may need to alter this accordingly).

Maintain electrolytes -

Prevent acidosis

Question 24

NEED TO WRITE UP on common complications of RRT as it is an ILO