CKD

Question 1

Define CKD

Answer 1

Abnormal kidney function or structure, present >3m

Haematuria or proteinuria will be present or a GFR <60 for 3m

Question 2

Outline the GFR categories

Answer 2

1 >90
2 60-89
3a 45-59
3b 30-44
4 15-29
5 <15

Question 3

What are the most common causes of CKD in the UK?

Answer 3

Hypertension
Diabetes
Glomerulonephritis

Question 4

What are the possible symptoms of CKD?

Answer 4

Anorexia
Nausea
Vomiting 
Fatigue
Weakness

Question 5

What are the investigations for CKD?

Answer 5

U&E
Hb (normocytic, normochromic)
Glucose 
Possible decreased calcium, increased phosphate 
Antiphospholipid antibodies 

Urine: Bence Jones protein, dipstick

Question 6

When do you refer a patient with CKD to nephrology?

Answer 6

If stage 4 or 5

Proteinuria with haematuria

Question 7

Which CKD patients do you offer an ACE/ARB to?

Answer 7

DM and A:CR of >3
Hypertension and A:CR of >30
Any CKD with A:CR >70

Question 8

How does CKD affect phosphate and vitamin D?

Answer 8

Causes increased serum phosphate and decreased vitamin D hydroxylation

Question 9

If a CKD patient is at risk of atherosclerotic events, what do you prescribe?

Answer 9

Low dose aspirin

Atorvastatin 20mg

Question 10

What is treatment for stage 1-2 CKD without uraemia?

Answer 10

ACE/ARB

Atorvastatin 20mg

Question 11

What is the treatment for stage 3-4 CKD without uraemia?

Answer 11

ACE/ARB

Atorvastatin 20mg

Question 12

What is the treatment for stage 3-4 CKD with anaemia?

Answer 12

ACE/ARB
Atorvastatin 20mg
Add epoetin alfa
Add ferrous sulfate

Usually a normochromic, normocytic anaemia

Question 13

What is the treatment of stage 3-4 CKD with hyperparathyroidism?

Answer 13

Ergocalciferol

Paricalcitol