CKD

Question 1

What is adult polycystic kidney disease?

Answer 1

Renal tubules become structurally abnormal = devel of multiple cysts

Autosomal dominant

Mutation either PKD1 or 2 gene

Cysts grow with age and present in adulthood

Can cause liver problems

Pain, bleeding into cysts, infection, more prone to UTI due to interrupted flow

Hypertension very common

Question 2

What is a normal GFR?

Answer 2

90-120 ml/min

Question 3

Define CKD

Answer 3

The irreversible and sometimes progressive loss of renal function over a period of months to years

Renal injury causes renal tissue to be replaced by extracellular matrix in response to tissue damage

Question 4

What is the aetiology of CKD?

Answer 4

DM

Hypertension

Glomerulonephritis

Infection – pyelonephritis

Genetic – APCKD

Obstruction

Vascular

Systemic disease

Question 5

How is CKD staged?

Answer 5

GFR level

Albuminuria level

Question 6

What continuously needs to be measured in CKD pts?

Answer 6

BP

Urine dip

Question 7

When is eGFR accurate?

Answer 7

In adults

Correction needed for black pts

Defines CKD

NOT useful in AKI

Question 8

How is CKD investigated?

Answer 8

Blood tests = U+Es, bone profile, LFTs, FBC, CRP, iron levels, PTH

Screening = auto-Ab, complement levels, anti-neutrophil cytoplasmic Ab, Ig (myeloma)

USS = kidney size, obstruction

Biopsy

Scans = CT, MRI, MR angiogram

Question 9

How can CKD be prevented?

Answer 9

Modifiable = Lifestyle, smoking, obesity, lack of exercise (improve QoL)

Stop PPI

Control DM

Control hypertension

Stop NSAIDs

Control proteinuria = give ACEi, Ang receptor blockers

Question 10

What is the role of the kidneys?

Answer 10

Regulation of = BP, blood volume, pH, electrolytes, osmolality

Excretion of waste prod

Met of drugs

Endocrine = renin, EPO

Question 11

How does CKD effect water/salt handling in the kidney?

Answer 11

Lose ability to maximally dilute and concentrate urine

Small glomerular filtrate but same solute load causes osmotic diuresis

Low volume of filtrate reduces maximum ability to excrete urine therefore maximum urine volume much smaller

Question 12

At what point does hyperkalemia occur in a CKD pt?

Answer 12

When eGFR <20ml/min

Less likely when good urine output maintained

Question 13

What causes anaemia in CKD?

Answer 13

Absolute iron def – high hepcidin levels (don’t absorb iron from the gut)

Decreased EPO prod

Blood loss

Short RBC life span

Bone marrow suppressed

Question 14

How is CKD linked to mineral bone disease?

Answer 14

CKD =

1) Phosphate retention leads to resistance of bone to PTH
2) low vit D

= hypocalcemia = secondary hyperparathyroidism

Question 15

How is CKD-BMD managed?

Answer 15

Reduce phosphate intake

Phosphate binders

1-alpha-calcidol

Vit D

Question 16

What symptoms are seen in ESRD?

Answer 16

Overwhelming fatigue

Physically and mentally incapacitated

Diff sleeping

Diff concentrating - oedema

Nausea, vomiting

Restless legs, cramps

Pruritus

Sexual dysfunction

Increased infections

Question 17

What options does a pt have when their kidney fails?

Answer 17

Haemodialysis = filtering the blood in a dialyzer connected to the vasculature

Peritoneal dialysis = specific solution is introduced through a permanent tube in the lower abdomen, waste products diffuse across the peritoneum from the underlying blood vessels into the fluid, which is then removed

Transplant = Reduced mortality and morbidity compared to dialysis

Question 18

A transplanted kidney normally is connected to the blood stream where?

Answer 18

Iliac vessels