CKD

Question 1

What is CKD?

Answer 1

Reduction in GFR <60ml/min/1.73m^2 >3m

Kidney damage = haematuria/ proteinuria, abnormalities on imaging

Question 2

What can cause CKD?

Answer 2

DM**
HTN**
GN
PKD
Obstructive uropathy
AKI

Question 3

What are the causes of obstructive uropathy?

Answer 3

Myeloma
Renal tumour
BPH
Stones

Question 4

Who should be offered (annual) CKD testing?

Answer 4

DM, HTN, AKI, CVD, obstructive uropathy, structural renal tract disease, multi-system disease involving kidney (SLE), FH of ESRF/PKD, opportunistic detection of haematuria

Question 5

What are the stages of of CKD?

Answer 5

Stage 1:
- Kidney damage GFR >90

Stage 2:
- Kidney damage GFR 60-89

Stage 3a:
- GFR 45-59

Stage 3b:
- GFR 30-44

Stage 4:
- GFR 15-29

Stage 5: ESRF

• GFR <15
• Needs RRT

Question 6

Which is the most common CKD stage?

Is stage 5 common?

Answer 6

Stage 3

No, stage 5 is not common

Question 7

If U&E is normal and there is no proteinuria in stages 1 and 2, is this considered CKD?

Answer 7

No

Question 8

Which factors affect the eGFR result?

Why?

Answer 8

• Pregnancy
• Body builders, amputees
• Eating red meat 12h prior to sample being taken

Creatinine is higher?

Question 9

How does it present?

Answer 9

Early stages are ASX

Question 10

When SX, which SX are present?

Answer 10

Malaise
Loss of appetite
Insomnia 
Fatigue, pallor - anaemia ( lack of EPO)
Oedema (salt + water retention)
Uraemia SX - nausea, pruritus, anorexia 
Nocturia, polyuria 
Oliguria - Advanced CKD, indicative of ESRF

Question 11

What signs might a pt have?

Answer 11

Increased skin pigmentation 
Excoriation 
Pallor
HTN
Postural hypoTN
Peripheral oedema 
Pleural effusion 
Peripheral neuropathy

Question 12

What is uraemia?

Answer 12

Raised level of urea in blood

Question 13

What are the SX of uraemia?

Answer 13

Metallic taste
Anorexia
N/V
Pruritus
Confusion

Question 14

What are the signs of uraemia?

Answer 14

Uraemic tinge - grey/yellow
Pericarditis - pericardial friction rub
Seizures
Bleeding

Question 15

What IX are needed?

Answer 15

Creatinine - high 
eGFR
ACR - >= 3mg/mmol = proteinuria
Urine dip - haematuria +1, glycosuria, casts
Renal USS - small kid, 

Other:
FBC - anaemia, normochromic normocytic
U&E - raised urea, low Na, high K
Blood glucose - DM
Serology - AAB
ECG - underlying CV abnormalities, hyperK
Bone profile - hypoCa, hyperPi, hyperPTH, high ALP

Question 16

What ACR values indicate proteinuria and when should you repeat?

Answer 16

3 - 70 mg/mmol
- repeat next early morning

If >70, no need for a repeat

Question 17

What are the complications of CKD?

Answer 17

Anaemia
Renal osteodystrophy
CVD
Protein malnutrition 
Metabolic acidosis
HyperK
Pulmonary oedema

Question 18

How is CKD MX?

Answer 18

STOP nephrotoxic drugs 
RX underlying cause
RX HTN
RX DM 
Statins, stop smoking, wt loss - CV risk 
Epoeitin alfa + oral ferrous sulfate 
Renal replacement therapy

Question 19

How is anaemia caused and how can it present?

Answer 19

Caused by iron deficiency/ EPO deficiency

Signs and SX

• Tachycardia
• Fatigue
• Pallor
• Aortic flow murmur - soft ejection systolic murmur that doesn’t radiate