CKD

Question 1

how would you treat bone disease caused by CKD?

Answer 1

1st line: reduce phosphate in diet 
phosphate binders;
- Ca based binders
- non-CBB i.e. Sevelamer 
vitamin D i.e. alfacalcidol, calcitriol 
parathyroidectomy

Question 2

decrease how CKD causes bone disease.

Answer 2

kidneys responsible for excreting potassium and phosphate therefore CKD = increased K and phosphate
Kidneys responsible for activation of vitamin D therefore CKD = vitamin D deficiency

low vitamin D = reduced absorption of Ca from intestines
high phosphate drags Ca out of bone and Ca binds to the phosphate = low Ca
low Ca activates parathyroid gland which increases Ca by taking it out of bone

Question 3

what is first line treatment for HTN in CKD?

Answer 3

ACE inhibitor (ramipril) or ARB (candesartan)

Question 4

if a patient who has CKD is on an ACE inhibitor for hypertension, is it a concern if their eGFR decreases and creatinine rises?

Answer 4

ACE inhibitors and ARB’s reduce filtration pressure so cause a slight reduction in eGFR and rise in creatinine

a decrease in eGFR by 25% and rise in creatinine by 30% is acceptable
any higher then there is renovascular disease

Question 5

what tip elf anaemia is seen in CKD?

Answer 5

normochromic normocytic anaemia

Question 6

at what GFR does anaemia in CKD usually become apparent?

Answer 6

GFR < 30

Question 7

when is furosemide useful in treating hypertension in CKD?

Answer 7

GFR < 45

Question 8

what is the target Hg of a patient with CKD + anaemia?

Answer 8

Hg 10-12 g/dl

Question 9

how would you treat anaemia in CKD?

Answer 9

if iron low - IV iron

erythropoietin stimulating agents (ESA) i.e. erythropoietin, darbopoeitin

Question 10

what are the different causes of anaemia in CKD?

Answer 10

reduced erythorpoeitin levels
reduced erythorpoesis due to toxic levels of uraemia in bone marrow
reduced absorption of iron (increased hepcidic due to chronic inflammation & reduced renal clearance)
anorexia/vomiting due to uraemia
reduced red cell survival (haemodialysis)
blood loss due to capillary fragility and poor platelet function
stress ulceration leading to chronic blood loss

Question 11

what are causes of CKD?

Answer 11

diabetic nephropathy 
hypertension 
glomerulonephritis 
polycystic kidney disease 
chronic pyelonephritis