CKD

Question 1

What are the causes of CKD?

Answer 1

could be systemic; diabetes mellitus, hypertension, hyperlipidaemia

chronic damage following renal diseases

autoimmune, e.g. SLE, Goodpasture’s

genetic; polycystic kidney disease

Question 2

What is the goal of CKD care?

Answer 2

• prevent cardiovascular problems
• prevent ESKD
• prevent complications of CKD
• prevent dialysis

Question 3

When to refer to a specialist? Re GFR

Answer 3

if GFR <30ml/min/1.73 m²

Sustained decrease of GFR of 25% or more

Question 4

What’s the relationship between Metformin and CKD?

Answer 4

Metformin should be
avoided if eGFR
below
30ml/min/1.73m²

Question 5

Which drugs might need dose reduced with CKD?

Answer 5

• beta blockers
• digoxin
• allopurinol
• opioids

Question 6

What are the first line antihypertensives for CKD?

Answer 6

ACEI, ARBs, and direct renin inhibitors

Question 7

Managing BP with CKD

NICE BP targets

Answer 7

CKD + NO diabetes

120-139/ <90mmHg

CKD + diabetes and people with ACR >70mg/n/mmol

120-129<80mmHg

Question 8

If uncontrolled hypertension in CKD then add:

Answer 8

non-dihydropyridine CCB
e.g. diltiazem

• If oedema consider loop diuretic

Question 9

What diuretics can you use in severe CKD?

Answer 9

Loops

(Thiazides only effective to GFR 20-25 ml/min)

+ remember can be used with Kidney stones

Question 10

Why do you get metabolic acidosis with CKD? And what’s the treatment?

Answer 10

Due to increasing inability of distal convoluted tubule to excrete hydrogen ions

Tx: Oral Sodium Bicarbonate

Question 11

What do you get atherosclerosis with CKD?

Answer 11

Associated with
abnormal lipid and
carbohydrate
metabolism, especially
in diabetics.

tx: Consider statins,
antiplatelets/
anticoagulants

Question 12

Which coexisting illnesses increase risk of CKD?

Answer 12

Diabetes,

Hypertension

CVD,

structural renal tract disease

multisystem diseases that affect the kidneys, eg. SLE

Question 13

Albuminuria; role in CKD diagnosis?

Answer 13

Persistent increased protein in the urine (two positive tests over 3 or more months) is the principal marker of kidney damage, acting as an early and sensitive marker in many types of kidney disease.

Question 14

What ACR level would indicate CKD?

Answer 14

30-300 mg/g for >3 months

(relative to young adult level)

Question 15

Tips for diagnosing CKD

Answer 15

• if GFR >60 ml/min/1.73m², then not CKD unless evidence of kidney damage.
• features must be present on at least two occasions and for more than three months.

Question 16

Investigations for CKD

Answer 16

U & E, glucose

24-hr creatinine clearance; determine level of renal failure

Casts; glomerulonephritis

Red Cells; can come from anywhere

Check < Calcium, phosphates

Question 17

CKD definition (albumin level, GFR)

Answer 17

albumin excretion of > 30mg/ day

or

GFR <60 ml/min/1.73 m²

for >3 mtns

** damage needs to be >3mtn to distinguish CKD from acute kidney disease.

Question 18

Definition of CKD

Answer 18

Abnormalities of kidney function or structure present for more than 3 months.

Includes all individuals with markers of kidney damage or those with an eGFR of less than 60 ml/min/1.73m2 on at least 2 occasions 90 days apart

(with or without markers of kidney damage).