CKD

Question 1

What is CKD?

Answer 1

Reduction in kidney function or structural damage present for more than 3 months
Associated with health implications

Question 2

What is GFR?

Answer 2

Glomerular filtration rate

Rate at which blood is filtered in the kidneys

Question 3

What is a normal GFR?

Answer 3

100-200 ml/minut/1.73m squared

Question 4

What are the two excretory functions of the kidney

Effects of CKD?

Answer 4

Inorganic substances (e.g. potassium & phosphate)
Organic (urea, creatinine)

CKD: hyperkalaemia, N&V

Question 5

What are the homeostatic functions of the kidneys?

Effects of CKD?

Answer 5

Normal: fluid balance
CKD: fluid retention/ polyuria/ nocturia

Normal: BP
CKD: HTN, pulmonary oedema

Normal: acid-base balance
CKD: metabolic acidosis

Question 6

What are the endocrine functions of the kidneys?

Effects of CKD?

Answer 6

Erythropoietin production
CKD: anaemia

Bone metabolism
CKD: bone minderal disorders, low serum calcium, bone pain

Question 7

What are the 3 main functions of the kidneys?

Answer 7

Excretory
Homeostasis
Endocrine

Question 8

When should you suspect CKD?

think creatinine & eGFR

Answer 8

Incidental finding of raised serum creatinine

Or eGFR <60

Question 9

Normal eGFR

Answer 9

> 90

Question 10

eGFR: Mild reduction (or not young adult)

Answer 10

60-89

Question 11

What is mild-mod CKD?

What stage?

Answer 11

45-59

Stage 3a

Question 12

What is mod-severe CKD?

What stage?

Answer 12

30-44

Stage 3b

Question 13

What is severe reduction of eGFR?

What stage?

Answer 13

15-29

Stage 4

Question 14

What eGFR means renal failure?

Answer 14

<15 (stage 5)

Question 15

What are possible findings on urine dip?

Answer 15

Proteinuria
Persistent haematuria
Urine sediment abnormalities

Question 16

What defines persistent haematuria?

Answer 16

2 of 3 urine dipsticks positive for blood

Question 17

Give some general symptoms you should ask about

Answer 17

Lethargy, itch, breathlessness, cramps, bone pain, anorexia, vomiting

Question 18

Give 7 nephrotoxic drugs

AA B C D LN

Answer 18

aminoglycosides
ACEi
Bisphosphonates
Ciclosporins
Diuretics
Lithium
NSAIDs

Question 19

How may someone present if they are uraemic?

Answer 19

Weakness, fatigue, muscle atrophy, tremors, abnormal mental function, metabolic acidosis

Question 20

If CKD is suspected, what blood tests should be arranged?

What should people not do before the blood test?

Answer 20

Serum creatinine & eGFR

Advise not to eat meat for 12 hours before

Question 21

If initial eGFR is <60 what should be done?

Answer 21

Repeat the test in 2 weeks

If <60 on repeat (with no evidence of AKI) repeat in 3 months

Question 22

What test is used to calculate ACR?

Answer 22

ACR (albumin: creatinine ratio)

Early morning urine sample

Question 23

How and when should CKD be diagnosed?

Answer 23

Persistent reduction in renal function (eGFR <60) and/ or proteinuria (urinary ACR >3)
FOR >3 MONTHS

Question 24

What is the most common cause of CKD

Answer 24

Diabetes

Question 25

How does diabetes cause CKD?

Answer 25

Glycation of the efferent arteriole. Increased pressure leads to hyperfiltration. This causes glomerulosclerosis

Question 26

How does HTN cause CKD?

Answer 26

Narrow arterial lumen means less blood & oxygen to the kidney. Leads to ischaemic glomerular injury & glomerulosclerosis

Question 27

Give 3 other causes of CKD

Answer 27

``` Systemic disease (e.g. lupus/ RA) Infection (HIV) Medication (e.g. long term NSAID use) ```

Question 28

What is defined accelerated progress of CKD?

Answer 28

Sustained decrease in eGFF of 25% or more from the baseline

Question 29

When should a patient with CKD be referred to a renal specialist? (4)

Answer 29

eGFR <30 Significant progression Significant proteinuria Complications

Question 30

When is dialysis usually needed?

Answer 30

When eGFR is <10

Question 31

What is dialysis?

Answer 31

Replaces the role of the kidneys: Diffusion of solutes between blood & dialysis fluid, removal of excess salt & water.

Question 32

What are the two kinds of dialysis?

Answer 32

Haemodialysis | Peritoneal dialysis

Question 33

How does haemodialysis work?

Answer 33

Access via fistula | 4 hours 3 times a week as an outpatient or in hospital

Question 34

How does peritoneal dialysis work?

Answer 34

Home therapy | Diffusion of solutes between blood in peritoneal capillaries & dialysis fluid in peritoneal cavity

Question 35

What are the two kinds of peritoneal dialysis?

Answer 35

CAPD (continuous ambulatory peritoneal dialysis) 4 x 2-3 litre exchanges per day APD (automated PD) several exchanges by machine whilst asleep at night

Question 36

What are 3 options for end stage renal failure?

Answer 36

Conservative care Dialysis Renal translpant

Question 37

Why are most patients not suitable for transplantation?

Answer 37

Co-morbidities

Question 38

What do patients require life-long after transplantation?

Answer 38

Life long immunosuppression