CKD

Question 1

What happens to the nephrons here

Answer 1

Irreversible loss of nephrons

Question 2

Is it symptomatic?

Answer 2

Asymptomatic until severe

Question 3

Causes?

Answer 3

•CVD
•UTI
• diabetes
• renal stones
• glomerular nephritis

Question 4

Diagnosis process

Answer 4

1. Test eGFR, if <60 repeat test after 2 weeks (to exclude AKI)
2. The test again. If eGFR <60 and ACR >3, repeat test after 3 months
3. • if eGFR <60 = diagnose
   • if ACR >3 = diagnose
   • if eGFR >60 = do not diagnose
   • if ACR <3 = do not diagnose

Question 5

Why are 2 readings spaced out 3 months apart?

Answer 5

• to deferentiate between AKI & CKD
• to see if it’s drug induced

Question 6

Process of renal Hypertension

Answer 6

1. Artery which carried blood to the kidneys become narrow due to atherosclerosis
2. Kidneys reduced blood flow is due to dehydration, so they release a hormone (aldosterone) which promotes the reabsorption of Na and water.
3. Now blood volume increase, resulting in HTN

Question 7

Treatment of renal HTN

Answer 7

ACEI or ARBs

if triple therapy doesn’t work then consider: starting angioplasty or bypass

Question 8

What is GFR and what low levels indicated

Answer 8

Measures how well kidneys filter waste

Low levels = dysfunction

Question 9

What does serum creatine conc measure and what does high levels indicate

Answer 9

It measure how well the kidney is function

High levels = kidney dysfunction

Question 10

What stage and eGFR is established kidney failure?

Answer 10

Stage 5

eGFR - <15

Question 11

Uremia is a sign/complication of severe CKD. What is it? Symptoms? And what can happen if left untreated

Answer 11

It is a build of waste in the blood (creatinine clearance = <10)

Signs:
• anorexia
• N&V
• muscle cramps
• changes in mental health

Complications of left untreated:
• coma
• sezuires
• cardiac arrest
• death

Question 12

What dose of statins would be used in primary and secondary prevention of CVD

~ CKD symptom management

Answer 12

Atorvastatin 20mg

Question 13

What would be the management of someone with reduced eGFR and diabetic

Answer 13

SGLT2 inhibitors

Question 14

Management of itching/prurits

~ CKD symptom management

Answer 14

Sedating antihistamines (chlorphenamine)

Question 15

Management of constipation

~ CKD symptom management

Answer 15

Moderate constipation - bulk forming laxatives

Severe constipation - stimulant laxatives

Question 16

Fluid retention

~ CKD symptom management

Answer 16

Directs or dialysis

Question 17

Management of anemia

~ CKD symptom management

Answer 17

• blood transfusion
• correct folate and iron
• erythropoietin

Question 18

Management of metabolic acidosis

~ CKD symptom management

Answer 18

Sodium bicarbonate

Question 19

Management of vitamin D deficiency

~ CKD symptom management

Answer 19

Alfaclcidol

Question 20

Management of hyperphosphatemia

~ CKD symptom management

Answer 20

1st
• calcium acetate (CI: hypercalcemia or low PTH)

If ^CI give sevelamar carbonate

Last choice: lanthanum

(In stage 4-5)

In other stages give diet

Question 21

Dietary restrictions in CKD

Answer 21

• low potassium
• low phosphates (dairy products)
• low protiens