CKD

Question 1

What is CKD?

Answer 1

Abnormal kidney structure or function > 3 months

Question 2

How is CKD classified?

Answer 2

• GFR

- Albuminuria

Question 3

What are common causes of CKD?

Answer 3

• Diabetes
• Glomerulonephritis
• Renovascular

Question 4

What are symptoms of CKD?

Answer 4

• SOB
• Anorexia
• N&V
• Pruritis
• Bone pain
• Amenorrhoea
• Impotence

Question 5

What are signs of CKD?

Answer 5

• Peripheral oedema
• Bruising from steroids
• Anaemia
• Xanthelasma
• Telangiectasia
• Raised JVP

Question 6

How can you diagnose CKD if the GFR is still > 60?

Answer 6

Other evidence of kidney damage

• Proteinuria/haematuria
• Pathology on biopsy/imaging
• Tubule disorder
• Transplant

Question 7

What are the first investigations you do in CKD?

Answer 7

GFR and testing for albumin in urine

Question 8

What blood tests do you do first in CKD?

Answer 8

U&E and Hb (when GFR < 60)

Question 9

What would you see on U&Es and Hb in CKD?

Answer 9

• Hypocalcaemia, hyperphosphataemia

- Normocytic anaemia

Question 10

What do you use to monitor CKD?

Answer 10

GFR and albuminuria

Question 11

What other investigations can you do in CKD?

Answer 11

• Renal osteodystrophy
• ANA and ANCA
• Antiphospholipid antibodies (anti cardiolipin)
• Renal biopsy

Question 12

How do you treat CKD to slow renal disease progression?

Answer 12

• ACE-i OR ARB - to lower BP and antagonise RAAS
• Glycaemic control
• Lifestyle - exercise, smoking cessation, reduce salt intake

Question 13

What is the issue with ACE-i/ARB in CKD?

Answer 13

Risk of hyperkalaemia and hypotension - don’t combine them, check K+ and renal function prior to and couple weeks after starting

Question 14

What are complications of CKD?

Answer 14

• Anaemia
• Acidosis
• Oedema
• Bone-mineral disorders
• Restless legs
• CVD

Question 15

What treatment should you give in CKD to prevent CVD?

Answer 15

• Low dose aspirin (antiplatelet)

- Atorvastatin 20mg

Question 16

How should you treat anaemia in CKD?

Answer 16

epo - erythropoietin stimulating agent (ESA) if Hb < 110

Question 17

How should you treat acidosis in CKD?

Answer 17

Sodium bicarbonate supplement if eGFR < 30 and serum bicarbonate < 20

Question 18

How should you treat oedema in CKD?

Answer 18

• Restrict fluid and sodium intake

- Loop and thiazide diuretic - distal tubule sodium excretion

Question 19

Why does CKD cause bone-mineral disorders?

Answer 19

Hyperphosphataemia + reduced hydroxylation of vitamin D by the kidney

Question 20

How should you treat bone-mineral disorders in CKD?

Answer 20

• Dietary restriction ± phosphate binders if phosphate > 1.5
• Vitamin D supplements (cole/ergocalciferol) if low vitamin D
• If high PTH treat with activated vitamin D analogue e.g. 1 alpha calcidol or calcitriol or paricalcitol

Question 21

How should you treat restless legs/cramps in CKD?

Answer 21

Gabapentin if severe (exclude iron deficiency)

Question 22

When should you plan for RRT?

Answer 22

In progressive CKD when the risk of renal failure is 10-20% within a year

Question 23

Which drugs need to be prescribed with care in CKD due to low GFR?

Answer 23

• Aminoglycosides
• Penicillins
• Cephalosporins
• Heparin
• Lithium
• Opiates
• Digoxin