CKD

Question 1

What is the current definition of CKD

Answer 1

Defined by either the presence of kidney damage ( blood/protein in urine) or GFR<50ml/min/1.73m2 which is present for more than 3 months

Question 2

Aetiology

Answer 2

• Diabetes
• Glomerulonephritis
• Hypertension
• Renovascular disease
• Polycystic kidney disease

Question 3

History

Answer 3

• Family history of Renal disease
• Previous indication of Renal disease
• Drug exposure
• Systemic disease
• Uraemic symptoms
• Pre/post renal factors

Question 4

Investigation

Answer 4

• Blood test
• Urine test
• Radiology: US
• Renal biopsy

Question 5

What do you test in a urine test

Answer 5

Protein to creatinine ratio

Albumin to creatinine ratio

Question 6

What blood tests do you do?

Answer 6

•	Urea, creatinine, elctrolytes 
•	Bicarbonate 
•	Total protein/ albumin 
•	Calcium/phosphates
•	LFT
•	Creatinine kinase 
•	Immunoglobulins
-Hematology : FBC including Hb, MCV, MCH, WBC, Platelets 
-Coagulation screen: PT, APPT, fibrogen

Question 7

How do you slow down the rate of decline?

Answer 7

• BP control is the most important
• Control proteinuria – ACE inhibitors
• Treat underlying cause
• others

Question 8

Potential complications of CKD and how to manage them

Answer 8

• Acidosis- Bicarbonate treatment
• Anaemia-EPO and iron
• Bone disease- diet and phosphate binders
• CV risk – BP, Aspirin, cholesterol, exercise, weight management
• Death & Dialysis- counsel and prepare
• Electrolytes- diet and consider drugs
• Fluid overload- salt and fluid restriction, diuretics
• Gout- optimise
• Hypertension- weight, diet, fluid balance
• Iatrogenic issues

Question 9

How to manage End stage renal disease

Answer 9

• Education
• select modality
• planning access
• deciding when to start
• multidisciplinary team

Question 10

How do you assess the function of the kidneys

Answer 10

• Filtration – Excretion function: use eGFR and blood test results
• Filtration- keep in function – check for presence of urine/protein in urine
• Anatomy- histology/imaging

Question 11

Up till what loss of function in the kidneys will creatinine loss be reduced

Answer 11

60%

Question 12

Things to consider when measuring creatinine

Answer 12

•	Creatinine is formed from the breakdown of muscle mass 
•	Not everyone has the same muscle mass:
-Age
-Ethnicity 
-Gender
-Weight
-Other issues such as liver disease

Question 13

Which are the equations you need to know to assess kidney damage?

Answer 13

Cockroft Gault
MDRD 4 Variable equation
CKD-EPI equation

Question 14

Stages of Kidney disease

Answer 14

Stage1: kidney damage/ normal or high GFR> 90%
Stage 2:kidney damage/ mild reduction in GFR 60-89%
Stage 3: Moderately impaired
a 45-59%
b 30-44%
Stage 4: Severely impaired: 15-29%
Stage 5: Advanced or on dialysis:<15%

Question 15

Ways of measuring GFR

Answer 15

• Inulin clearance test
• Isotope GFR
• 24h urine test + blood test
• GFR estimating equations : Creatinine