CKD

Question 1

What is CKD?

Answer 1

Chronic kidney disease

Presence of kidney damage for more than 3 months (eGFR<60)

Question 2

What is evidence for CKD?

Answer 2

Albuminuria 
Proteinuria
Haematuria 
Structural kidney abnormalities 
Glomerulonephritis

Question 3

What can cause CKD?

Answer 3

Diabetes
Hypertension 
Glomerulonephritis
Polycystic kidney disease
Chronic pyelonephritis 
Obstructive nephropathy

Question 4

What is stage 1 CKD?

Answer 4

eGFR >90 with evidence of kidney damage

Question 5

What is stage 2 CKD?

Answer 5

eGFR 60-89 with evidence of kidney damage

Question 6

What is stage 3a CKD?

Answer 6

eGFR 45-59

Question 7

What is stage 3b CKD?

Answer 7

eGFR 30-44

Question 8

What is stage 4 CKD?

Answer 8

eGFR 15-29

Question 9

What is stage 5 CKD?

Answer 9

eGFR <15

Question 10

What is PKD?

Answer 10

Polycystic kidney disease

- genetic disease characterised by multiple cysts on the kidneys

Question 11

What is the inheritance of PKD?

Answer 11

Autosomal dominant

Question 12

How can CKD present?

Answer 12

Early CKD has no symptoms

Later

• anorexia
• nausea
• vomiting
• pruritus
• oedema

Question 13

How do you investigate suspected CKD?

Answer 13

Urine ACR

Bloods

• FBC
• U+Es
• phosphate
• calcium
• immunoassay (complement, ANCA, anti GBM)

USS KUB

Question 14

How do you manage CKD?

Answer 14

Treat underlying cause

BP control
Treat electrolyte abnormalities
Renal replacement therapy

Question 15

What are the complications of CKD?

Answer 15

Anaemia of CKD
Mineral + bone disease
Secondary/tertiary hyperparathyroidism
Hypertension

Question 16

What type of anaemia is associated with CKD?

Answer 16

Normocytic - anaemia of chronic disease

Question 17

What can cause anaemia in CKD?

Answer 17

Reduced erythropoietin production

Iron deficiency

Question 18

How do you manage anaemia in CKD?

Answer 18

Measure

• B12
• folate
• ferritin
• iron

Replace anything that is deficient

Aim for Hb of 100-120

Question 19

How can CKD cause mineral bone disease?

Answer 19

Increased ALP + PTH
Increased phosphate
Decreased serum calcium

Question 20

How is CKD-mineral bone disease diagnosed?

Answer 20

1 or more of

• abnormality of calcium, phosphate, ALP, PTH or vit D metabolism
• vascular or soft tissue mineralisation
• abnormality in bone turnover, metabolism, volume or strength

Question 21

What are risk factors for CKD?

Answer 21

Increasing age
HTN
DM
Smoking
Nephrotoxic medications

Question 22

What are features of CKD?

Answer 22

Pruritus
Anorexia
Nausea
Oedema
HTN

Question 23

How is CKD staged?

Answer 23

GFR

Urine ACR

Question 24

What is an ACR stage one score?

Answer 24

ACR <3mg/mmol

Question 25

What is an ACR stage two score?

Answer 25

ACR 3-70mg/mmol

Question 26

What is an ACR stage three score?

Answer 26

ACR >70mg/mmol

Question 27

When should a patient with CKD be referred to a specialist?

Answer 27

4 variable kidney risk assessment >5%
ACR > 70mg/mmol
ACR >30mg/mmol + haematuria
GFR decreases by >25% or >15 in a year
Persisting hypertension despite 4 antihypertensives

Question 28

What is the BP aim in a patient with ACR >70mg/mmol?

Answer 28

<130 systolic

<80 diastolic

Question 29

What is the BP aim in a patient with ACR <70mg/mmol?

Answer 29

<140 systolic

<90 diastolic

Question 30

How is BP controlled in CKD patients?

Answer 30

RAAS antagonists

• ARBs
• ACEi

Question 31

How is high phosphate managed in CKD patients?

Answer 31

Phosphate binders

• calcium acetate (not if calcium is high)
• sevelamer acetate