CKD

Question 1

why should blood transplants be avoiding in pts awaiting renal transplant

Answer 1

risk of sensitisation (i.e. development of antibodies) to human leucocyte antigens (HLA)

Question 2

what is chronic kidney disease

Answer 2

the presence of kidney damage or reduced kidney function for three or more months which is not reversible and may be progressive, characterised by reduction in GFR

Question 3

8 major causes of CKD

Answer 3

1. Hypertensive nephropathy
2. Diabetic nephropathy
3. Glomerulopathies
4. Inherited kidney disorders (e.g. PCKD)
5. Ischaemic nephropathy (e.g. vascular disease)
6. Obstructive uropathy
7. Tubulointerstitial diseases
8. Medications

Question 4

what are the 3 parts to CKD staging

Answer 4

1. cause
2. glomerular stage
3. albuminuria stage

Question 5

what are the glomerular stages in CKD

Answer 5

G1 - normal/high eGFR (>90)
G2 - mildly decreased eGFR (60-89)
G3a - mildly to moderately decreased (45-59)
G3b - moderately to severely decreased (30-44)
G4 - severely decreased (15-29)
G5 - kidney failure (<15)

Question 6

what are the albumin stages in CKD

Answer 6

A1 - normal to mildly increased (<30mg/g)
A2 - moderately increased (3-300 mg/g)
A3 - severely increased (>300 mg/g)

Question 7

markers of kidney disease (4)

Answer 7

1. GFR <60
2. albuminuria/haematuria
3. electrolyte abnormaities due to tubular disorders
4. structural/histological abnormalities

Question 8

how many eGFR calculations are required for CKD diagnosis

Answer 8

2 samples, 90 days apart

Question 9

if a pt has high serum creatnine conc, what should the diagnosis be treated as

Answer 9

AKI until proven otherwise

Question 10

why must BP be kept above 120 systolic in CKD

Answer 10

otherwise the kidneys wont be perfused
properly and won’t be able to filter

but must keep BP below 140 to stop progression

Question 11

why are ACEi/ARBs frequently used in CKD

Answer 11

they block the action of Ang II -> dilation of efferent arteriole -> reduction in GFR and increased tubular BF

Question 12

at what stage should non-conservative mgx be implemented in CKD

Answer 12

stages IIIb and above -> mineral balances start to become important

Question 13

complications of CKD (6)

Answer 13

1. anemia
2. mineral bone disorders
3. salt/water disorders
4. acid base disorders
5. uraemia
6. disease specific complications

Question 14

why does a functional iron deficiency develop with CKD (IIIb+)

Answer 14

EPO cannot be made meaning that RBC count drops

Question 15

what is a functional iron deficency

Answer 15

adequate iron stores but insufficient iron availability for incorporation into erythroid precursors

Question 16

why is hyperphosphataemia seen in CKD (5)

Answer 16

1. phosphate is difficult to clear from the blood -> as tubular function declines, phosphate builds up
2. high phosphate results in lover Calcium
3. PTH levels rise in response
4. Ca AND PO4 relased from bones
5. PO4 remains high

Question 17

CKD stage V mgx

Answer 17

1. start preparation for RRT
2. close monitoring of progression
3. manage salt/water problems

Question 18

what is the main risk of peritoneal dialysis

Answer 18

peritonitis or even encapsulating peritoneal sclerosis in severe cases