CKD

Question 1

What is CKD

Answer 1

CHRONIC KIDNEY DISEASE is the decline in renal function for more than 3months

Question 2

Causes of CKD

Answer 2

HYPERTENSION
GLOMERULOSCLEROSIS
DIABETES (DIABETIC NEPHROPATHY)
GLOMERULONEPHRITIS
PCKD
NSAIDS OVERUSE
PROGRESSIVE AKI

Question 3

Clinical manifestations of CKD

Answer 3

Hyperkalemia
Hypocalcemia
Hyperphosphatemia
Edema
Albuminuria
Azotemia/ Uremia symptoms
Secondary hypertension

Question 4

What are uremia symptoms

Answer 4

Encephalopathy
Seizures
Coma
Asterixis
Platelets Dysfunction
Pleural effusion
Uremic pericarditis
Uremic frosts on skin

Question 5

Complications of CKD

Answer 5

Hyperparathyroidism
Uremia symptoms
Secondary hypertension
Chronic disease Anemia
Renal Osteodystrophy
Metabolic acidosis

Question 6

Diagnosis of CKD

Answer 6

1) HISTORY
>3months of kidney injury evidence

2) MARKERS OF KIDNEY INJURY
a) GFR<90
b) ALBUMINURIA
- Through urine analysis (Albumin-creatinine ratio ACR)

3) RENAL ULTRASOUND
- Small atrophic fibrotic kidneys
- Cysts
- Decreased perfusion & vascularity by Doppler US

4) RENAL BIOPSY & SEROLOGY
- To check for glomerular Nephritis

5) ADDITIONAL LABS
i) BMP
- K+ high
- PO4 high
- Ca2+ low
- Na+ high/low
- GFR low
- Creatinine low
- HCO3 low
ii) CBC
- normocytic anemia
- check iron
iii) ABG (acidosis)
iv) LIPID PANEL
- LDL high
- Triglycerides high
v) PTH high

Question 7

What are the stages of CKD based on GFR

Answer 7

1) STAGE I
GFR>/= 90

2) STAGE II
GFR= 60-89

3) STAGE III
• STAGE III A
GFR= 45-59
• STAGE III B
GFR= 30-44

4) STAGE IV
GFR= 15- 29

5) STAGE V
GFR <15

Question 8

What are the stages of albuminuria by albumin-creatinine ratio (ACR)

Answer 8

1) MILD
ACR<30

2) MODERATE (MICRO)
ACR= 30-299

3) SEVERE (MACRO)
ACR>/=300

Question 9

Treatment of CKD

Answer 9

a) HYPERTENSION
- ACE INHIBITORS, ARB’S K+ SPARINS DIURETICS to regulate RAAAS
- LOOP DIURETICS
- RESTRICTED Na & H20 INTAKE

b) DIABETES
- INSULIN
- ANTIDIABETICS for type 2
- WEIGHT LOSS
- DIET CHANGE

c) GLOMERULONEPHRITIS
- STEROIDS
- DMARDS
- TREAT UNDERLYING CAUSES

d) POLYCYSTIC KIDNEY DISEASE
- RENAL TRANSPLANT

e) NSAIDS DISCONTINUATION

f) COMPLICATIONS MANAGEMENT
- LOOP DIURETICS, THIAZIDE DIURETICS for high K+
- SEVELAMER HCL for high PO4
- CALCIUM ACETATE & VIT D for low Ca2+
- CINACALCET/ PARATHYROIDECTOMY for secondary/ tertiary hyperparathyroidism
- SYNTHETIC EPO for low EPO & anemia
- NaHCO3 for acidosis
- ACE INHIBITORS & ARB’S for albuminuria
- STATINS for high TG & LDL
- DDAVP for platelets dysfunction

g) RENAL REPLACEMENT THERAPIES
- DIALYSIS
- RENAL TRANSPLANT

Question 10

What are the indicators for dialysis

Answer 10

ACIDOSIS
HYPERKALEMIA
DRUG INTOXICATION
OVERLOAD VOLUME
UREMIA