CKD

Question 1

CKD = increased risk of

Answer 1

Peptic ulcers

Cardiovascular problems

Question 2

Extra-renal manifestations

Answer 2

Gouty tophi
Splinter haemorrhages (haematuria, proteinuria)

Question 3

Asymptomatic range of proteinuria

Answer 3

less than 1g

Question 4

Heavy proteinuria range

Answer 4

1-3g/day

Question 5

Nephrotic proteinuria range

Answer 5

over 3g/day

Question 6

Isomorphic RBCs

Answer 6

LUT

Round

Question 7

Dysmorphic RBCs

Answer 7

UUT

Squished, escaping

Question 8

Hyaline casts

Answer 8

Benign

Question 9

Red cell casts

Answer 9

Always pathological
Nephritic syndrome
Dysmorphic red cells
Bleeding through glomerulus into tubule

Question 10

Leukocyte casts

Answer 10

Infection or inflammation

Question 11

Granular casts

Answer 11

CKD

Question 12

Severe renal impairment ECG

Answer 12

Tall r waves, depressed ST segment, inverted T waves

Question 13

CKD stages

Answer 13

Stage 1: over 90 with kidney damage (proteinuria or abnormality on scanning)
Stage 2: 60-90 with kidney damage
Stage 3: 30-60
Stage 4: 15-30
Stage 5: less than 15

Question 14

Define CKD

Answer 14

Reduced GFR and kidney damage

Question 15

How to assess CKD

Answer 15

Urinalysis - proteinuria, haematuria
Nuclear medicine (radioactive label)
Creatinine clearance (eGFR)
Serum creatinine
ACR
UandEs

Question 16

What is creatinine?

Answer 16

Breakdown of protein

Question 17

When is eGFR less accurate?

Answer 17

greater than 60ml/min

Question 18

As creatinine increases, GFR _____________

Answer 18

decreases

Question 19

Who is more likely to progress?

Answer 19

Younger

Proteinuria

Question 20

Causes of CKD

Answer 20

Diabetes
HT
Vascular disease
Chronic GN
Reflux nephropathy
PCKD

Question 21

Symptoms of CKD

Answer 21

Don’t occur til less than 20 GFR

Fatigue, poor appetite, itch, sleep disturbance, uraemia (rub), nocturia

Question 22

How to slow progression

Answer 22

Reduce proteinuria
Control HT and CV risk factors (smoking, exercise, statin in stage 4)
ACEI/ARB - reduce BP and proteinuria
Spironolactone
Glycaemic control in diabetics

Question 23

Caution with intial use of ACEI/ARB

Answer 23

Initial fall in GFR

Indirectly reduce aldosterone = hyperkalaemia

Question 24

Complications of CKD

Answer 24

Anaemia
Bone disease
Hyperparathyroidism

Question 25

Where is erythropoietin produced?

Answer 25

Kidneys = reduced in CKD = anaemia

Question 26

How to treat anaemia

Answer 26

Check iron status, B12 and folate IV iron Erythropoietin (epo) injection - IV iron top ups

Question 27

Where is Vit D hydroxylated?

Answer 27

Liver and kidney = impaired in CKD = reduced Ca absorption = secondary hyperparathyroidism = tertiary after a while

Question 28

Phosphate in CKD

Answer 28

Less phosphate excreted in CKD = serum phosphate rises = stimulates PTH

Question 29

What does high Ca and phosphate cause?

Answer 29

Vessel calcification = vascular disease, valve problems

Question 30

Treatment for hypocalcaemia and hyperphosphataemia

Answer 30

``` Alfacalcidol (hydroxylated Vit D) Phosphate (diet) Phosphate binders (take with every meal) ```

Question 31

How often should serum creatinine be measured?

Answer 31

``` Every year (patients with stage I and II CKD, HT, diabetes) Every 6 months (patients with stage III-V) ```

Question 32

When are ACEIs contraindicated?

Answer 32

Bilateral renal artery stenosis (may lead to hypoperfusion)