CKD

Question 1

What is GFR?

Answer 1

Measure of kidney function, estimated with eGFR

Volume of fluid filtered from renal glomerular capillaries into Bowman’s capsule (mL/min)

Question 2

What does CKD look like on ultrasound?

Answer 2

Small, shrunken kidneys (< 9cm)

Increased cortical echogenecity

Question 3

What is the definition of CKD?

Answer 3

Presence of kidney damage (hematuria, proteinuria or anatomic abnormality)

OR

eGFR < 60

for 3+ months and not treated with dialysis or transplant

Question 4

What are the most common causes of CKD?

Answer 4

Diabetic glomerulosclerosis
Vascular disease (HTN, renal A stenosis)
Glomerular disease

Question 5

How to delay CKD (5)?

Answer 5

1. ACEi or ARB
2. BP control (< 7%)
3. if eGFR < 60, avoid NSAIDs and IV contrast (nephrotoxins)

Question 6

How does CKD cause anemia?

Answer 6

Decreased GFR decreases EPO production, leading to anemia

Question 7

How does CKD cause bone mineral dysfunction?

Answer 7

CKD results in decreased phosphate excretion and inability to activate vitamin D

Elevated serum phosphate results in formation of insoluble calcium phosphate and hypocalcemia

Calcium normally inhibits PTH secretion, so hypocalcemia results in hyperparathyroidism (secondary to CKD)

PTH releases Calcium from bones

Question 8

What are the clinical features of CKD?

Answer 8

Volume overload
HTN
Electrolyte and acid-base disturbances (metabolic acidosis)
Uremia

Question 9

What are the indications for dialysis in CKD?

Answer 9

Hyperkalemia, metabolic acidosis refractory to medical therapy
Fluid overload refractory to diuretics
Progressive uremia (encephalopathy, pericarditis, N/V)

Question 10

What are the goals of dialysis?

Answer 10

Solute/toxin removal

Salt and water removal

Question 11

What are the options for dialysis?

Answer 11

Hemodialysis (tunneled catheter)
Peritoneal dialysis

No difference in outcomes, driven by patient choice

Question 12

What are the advantages of kidney transplant over dialysis?

Answer 12

Improves quality of life and reduces mortality

Transplant is heterotopic (original kidneys left in)