CKD

Question 1

Symptoms of ADPKD

Answer 1

Haematuria, hypertension, nephrolithiasis, ERSD, upper UTIs, bilateral flank masses, abdo pain

Question 2

How do you manage ADPKD

Answer 2

ACEi to manage hypertension
Tolvaptan to slow cyst growth
Antibiotics to treat upper UTIs
If esrd then dialysis and transplant

Question 3

Define CKD

Answer 3

Irreversible decline in kidney function over months years

+/- progressive

Question 4

Causes of CKD

Answer 4

Biggest is diabetes
Second biggest is hypertension
Then ADPKD, Alports, SLE

Question 5

How do you stage CKD

Answer 5

G for GFR grading. Less than fifteen is g5

A for acr albumin creatinine ratio

Question 6

Describe complications/effects of CKD

Answer 6

Acidosis
Hyperkalemia and arrhythmias
Anemia from reduced epo
Reduced calcitriol so hypocalcemia
Renal osteodystrophy- bone cysts, terminal phalange erosion,
Calcium phosphate deposits in skin, bones, joints
High PTH
Waste accumulates causing nausea, vom, pruritis

Question 7

What happens in terms of pathology to the kidney in CKD

Answer 7

Kidney damaged, ECM replaces renal tissue, cortex shrinks, filled with inflammatory cells and scarring

Question 8

What is ESRF

Answer 8

When death is likely without renal replacement therapy ie dialysis or transplant
Egfr less than 15/mls min

Will have overload signs eg sob oedema,
nausea vom anorexia, pruritis

Question 9

Name dialysis options

Answer 9

Haemodialysis- out of artery into vein for four hours three times a week
Peritoneal dialysis-
CAPD continuous ambulatory
APD automated which is overnight

Question 10

Which dialysis type would you prefer

Answer 10

Maybe automated peritoneal dialysis that’s overnight
Responsible for own care
No travel time
Can fit into life
Easier to go away
Less diet fluid restrictions than haemodialysis

Question 11

What disadvantages of renal transplant are there

Answer 11

Malignancy risk post infection is higher
Now on immunosuppressants, side effects, infection risk
Peri operative mortality risk

Question 12

What is CKD-MBD

Answer 12

Mineral bone disorder associated with CKD
Reduced calcitriol production by kidney and reduced phosphate excretion
Bony changes- high phosphate and low calcium means bony cysts and terminal phalange erosion

Non bony changes are calcium phosphate deposits in skin, joints and bones