CKD

Question 1

What is CKD?

Answer 1

abnormalities in kidney function or structure (or both) present for more than 3 months with associated health implications

Question 2

When should CKD be diagnosed?

Answer 2

GFR less than 60 mL/min/1.73 m2 on at least two occasions separated by a period of at least 90 days

urinary albumin:creatinine ratio (ACR) greater than 3 mg/mmol, urine sediment abnormalities, electrolyte and other abnormalities

Question 3

What are some complications associated with CKD?

Answer 3

AKI

hypertension

CVD

renal anaemia

renal mineral and bone disorder

end-stage renal disease (ESRD)

increased all-cause mortality

Question 4

What should be monitored in a patient diagnosed with CKD?

Answer 4

eGFR

Urinary ACR

FBC to exclude renal anaemia

Serum Calcium, Phosphate, Vit D and Parathyroid hormone

Question 5

What are some risk factors for CKD?

Answer 5

HTN

Diabetes mellitus

Glomerular disease

History of AKI

Nephrotoxic procedures (radiotherapy) or drugs: Aminoglycosides, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), bisphosphonates, calcineurin inhibitors (such as ciclosporin or tacrolimus), diuretics, lithium, methotrexate, proton pump inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs)

Family history

CVD

Gout

SLE, HIV, vasculitis, myeloma

Question 6

What investigations should be done for someone with suspected CKD?

Answer 6

Blood test for serum creatinine and eGFR

Early morning urine sample for ACR

Urine dipstick for haematuria

Question 7

How is CKD classified?

Answer 7

Using eGFR and ACR

Question 8

How should CKD be managed in primary care?

Answer 8

Assess and manage causes and risk factors for disease progression e.g. stop nephrotoxic drugs

Help pt manage lifestyle factors

Manage CVD risk

Assess and manage HTN - can offer ACEi or ARB

Question 9

What lifestyle measures can be taken to manage CKD?

Answer 9

Smoking cessation

Drink alcohol in moderation

Maintain healthy body weight

Regular exercise

Eat healthy diet

Question 10

When should AKI be suspected?

Answer 10

Symptoms and signs such as:
-Nausea and vomiting, dehydration, diarrhoea
-Reduced urine output
-Confusion, fatigue or drowsiness

Acute illness

CKD patients who are ill

New onset LUTS

Question 11

What is hypertension?

Answer 11

Persistently raised arterial blood pressure

Can be primary or secondary

Has 3 stages