CKD

Question 1

definition

Answer 1

impaired renal function for >3 months based on abnormal structure or function- GFR < 60 ml/min/1.73m2

Question 2

how many stages are there on classification and when do symptoms usually occur

Answer 2

5 stages, symptoms after stage 4

Question 3

what is end stage renal failure defined as

Answer 3

GFR <15ml/min/1.73m2 or need for renal replacement therapy

Question 4

causes of CKD

Answer 4

diabetes, glomerulonephritis, unknown, hypertension/renovascular disease, pyelonephritis and reflux nephropathy

Question 5

what is a common inherited cause of CKD

Answer 5

adult polycystic kidney disease

Question 6

who is screening recommended for

Answer 6

diabetics, hypertension, cardio disease, structural renal disease stones of BPH, recurrent UTIs, multisystem disorders which could affect kidney eg SLE, fhx, opportunistic detection haematuria and proteinuria

Question 7

what are uraemic symptoms

Answer 7

high urea symptom renal failure- anorexia, vomiting, restless legs, fatigue, weakness, pruritis, bone pain

Question 8

what would be found on examination

Answer 8

pallor, uraemic tinge to skin (yellowish), purpura, excoriations, incr bp, cardiomegaly, signs fluid overload. can present severe uraemia, hyperkalaemia, encephalopathy, seizures, coma

Question 9

what tests can be done

Answer 9

blood, urine, imaging, histology

Question 10

tests- blood

Answer 10

Hb (normochromic, normocytic anaemia), ESR, U&E, glucose, decr Ca2+, incr PO34, incr ALP. incr PTH if stage 3 or more

Question 11

tests- urine

Answer 11

dipstick, MC&S, ACR, PCR

Question 12

tests- imaging

Answer 12

USS

Question 13

examining the patient- periphery

Answer 13

hypertension, arteriovenous fistula, signs prev transplant, skin malignancy

Question 14

examining the patient- face

Answer 14

pallor of anaemia, yellow tinge of uraemia, gum hypertrophy from ciclosporin, cushingoid appearance from steroids

Question 15

examining the patient- abdomen

Answer 15

catheter, or sign previous, ballotable polycystic kidneys, liver

Question 16

signs elsewhere on examination

Answer 16

diabetic neuropathy, retinopathy, cardio, peripheral vascular disease

Question 17

what is the GFR in stage 1

Answer 17

> 90 ml/min. evidence renal damage (proteinuria, haematuria, abnormal anatomy, systemic disease)

Question 18

what is the GFR in stage 2

Answer 18

60-89. evidence renal damage(proteinuria, haematuria, abnormal anatomy, systemic disease)

Question 19

what is the GFR in stage 3

Answer 19

a- 45-59. b- 30-44. without evidence other renal damage (proteinuria, haematuria, abnormal anatomy, systemic disease)

Question 20

what is the GFR in stage 4

Answer 20

15-29. without evidence renal damage (proteinuria, haematuria, abnormal anatomy, systemic disease)

Question 21

what is the GFR in stage 5

Answer 21

<15. renal failure

Question 22

what is a falling GFR an independent risk factor for

Answer 22

cardiovascular disease

Question 23

when to refer to a nephrologist

Answer 23

stage 4-5; proteinuria, haematuria, rapidly falling GFR, incr BP, genetics, suspected renal artery stenosis

Question 24

what is management of CKD split into

Answer 24

investigation (identify and treat causes), limiting progression/complications, symptom control and prep for RRT

Question 25

what is the target bp in CKD pt

Answer 25

70)

Question 26

what are you at risk with in CKD (renal bone disease)

Answer 26

osteodystrophy, adynamic bone disease- treat raised PTH. PO4^3- rises in CKD thus incr PTH. restrict diet, give binders to decr gut absorption. vit D analogues and ca2+ supplements

Question 27

how to modify cardio risk

Answer 27

risk from cardio death higher in stage 1 and 2 than ESRF. give statins and aspirin

Question 28

symptom control

Answer 28

anaemia- replace iron/B12/folate; acidosis- sodium bicarb (caution in hypertension as sodium load can incr bp); oedema- loop diuretics furosemide, restrict fluid and salt; restless legs/cramps- check ferritin, clonazepam or gabapentin may help

Question 29

contraindications to renal biopsy

Answer 29

abnormal clotting, hypertension, single kidney, CKD with small kidneys, horseshoe kidney, renal neoplasms