CKD

Question 1

CKD STAGING

Answer 1

GFR category (ml/min/1.73m2) Albuminuria category (mg/mmol)
G1 >90
G2 60–89
G3a 45–59
G3b 30–44
G4 15–29
G5 <15

Question 2

Risk factors for CKD (9)

Answer 2

Diabetes
Hypertension (HTN)
History of AKI
Cardiovascular diease
Structural renal disease
Systemic disease eg. SLE
Gout
Family history (FH) of CKD
Haematuria or proteinuria

Question 3

Investigation of ckd

Answer 3

• eGFR, ACR,
• bloods - FBC, U&Es, LFT, HbA1c, bone profile, HCO3, lipid profile
  *BP
  *urine dipstick + MC&S

*renal US

Question 4

Most common causes of CKD

Answer 4

Diabetes
HTN
Polycystic kidney disease

Question 5

Other causes of CKD

Answer 5

1. Glomerular - IgA, SLE
2. Vascular - vasculitis
3. Tubulointerstial amyloidosis, myeloma
4. Congenital - polyccystic kidney disease, alport syndrome

Medications - NSAID, lithium

Question 6

Complications of ckd

Answer 6

Waste excretion – uraemia and hyperphosphataemia
Regulation of fluid balance – HTN and peripheral/pulmonary oedema
Acid–base balance – metabolic acidosis
Erythropoietin production – anaemia
Activation of vitamin D – hypocalcaemia

Question 7

Management - perserving kidney function

Answer 7

• heighty weight, smoking stop
  *HTN control <140/90 + ACR <70
  Diabetes : aim less than 53mmol/mol
  Review nephrotoxic meds
  Statin + clopidogrel - 2ndary prevention.

Question 8

Mangining complication of ckd

Answer 8

HTN: aim for BP < 140/90 mmHg in patients with CKD and ACR < 70/PCR < 100; or <130/80 mmHg in patients with ACR > 70/PCR > 100 or diabetes
Proteinuria: ACE-is/ARBs
Anaemia: correct fe defiency + give epo replacement
CKD–mineral bone disorder: managed with dietary phosphate restriction, phosphate binders and activated vitamin D.
Fluid: fluid and salt restriction + diuretics
Acid–base status: aim for a serum bicarbonate level of >22 mEq/l

Question 9

Referal to nephrology if: (ACR, eGFR related)

Answer 9

uACR > 70 mg/mmol (unless secondary to diabetes)
uACR > 30 mg/mmol with haematuria
A descrease in eGFR of >25% or change in eGFR category within 12 months
A decrease in eGFR of 15 ml/min/1.73m2 or more per year

Question 10

What happens in CKD to phosphate, Ca, 1,25 D3

Answer 10

Phospahte builds up,
decreased 1,25(OH)D3,
low/normal calcium
leads to PTH secretion
and secondary hyperparathyroidism

2ndary hyperparathyroidism - leads to abnormal bone turnover.

Question 11

What drugs to use in 2ndary hyperparathyroidism

Answer 11

• sevelamer - phosphate binders
  *Alfacalcidol - activated vit D analogue
  *Cinacalet - calcimimetics
  *Dialysis