CKD

Question 1

how is CKD classified?

Answer 1

according to eGFR

1 = >90
2= 60-89 
3a = 45-59
3b = 30-44 
4 = 15-29 
5 = <15 

A1 = albumin excretion <30mg/24hr and Albumin:creatine ratio <3

A2 = albumin excretion 30-300 and A:C 3-30

A3 = Albumin excretion >300 and A:C >30

Question 2

what are the causes of CKD?

Answer 2

DM 
HTN 
PKD 
Obstructive uropathy 
nephrotic and nephritic syndrome Glomerulonephritis

Question 3

what are the symptoms of CKD?

Answer 3

pruritis 
fatigue 
Nausea
Dyspnoea
nocturia
joint pain 
confusion 
restless leg

Question 4

what are the signs of CKD?

Answer 4

oedema 
pericardial rub 
rash 
HTN 
tachyapnoea 
cachexia 
Jaundice

Question 5

what InV are done in CKD?

Answer 5

renal chemistry and eGFR

• increased serum creatinine
• decreased eGFR

Urinary albumin - increased

urinalysis
- haematuria and/or proteinuria

renal imaging and biopsy

Question 6

what are the treatment options to slow progression of CKD?

Answer 6

BP control
- ACEi or ARB

Glycaemic control

Statins
- reduce adverse CV events

Lifestyle change
- exercise, decrease weight, smoking cessation, decreased salt intake

Question 7

what are the complications of CKD and the treatments used to prevent?

Answer 7

anaemia

• EPO
• ferrous sulphate or gluconate

acidosis
- sodium bicarb supps

oedema

• restrict sodium and fluid intake
• loop diuretic

Bone and mineral disorders

• increased phos and decreased vit D
• phos binders and ergocalciferol

hyperkalaemia

• oral K+ binders
• emergency drugs

Question 8

what are the indications for RRT in CKD?

Answer 8

eGFR <15

inability to control volume status i.e pulmonary oedema

inability to control BP

Serositis

persisitent electrolyte disturbances

cognitive impairement

Question 9

what are the principles and problems in haemodialysis?

Answer 9

blood is passed over a semi permeable membrane against dialysis fluid flowing in opposite direction. Diffusion of solutes against conc gradient

Hydrostatic gradient used to clear excess fluid as required (Ultrafiltration)

access via arteriovenous fistula. 3x a week for 4 hours

Problems

• dialysis disequalibrium
• hypotension
• time consuming

Question 10

what are the principles and problems in peritoneal dialysis?

Answer 10

uses the peritoneum as the semi permeable membrane with catheter inserted into peritoneal cavity and fluid infused

Ultrafiltration achieved by adding osmotic agents ton the fluid

continous process with intermittent drainage and refilling

Problems

• infection
• hernia
• peritonitis
• loss of membrane function over time

Question 11

what are the complications of RRT?

Answer 11

renal bone disease
- high bone turnover, renal osteodystrophy

infection

• at site
• uraemia causes granulocyte and t cell dysfunction

Amyloid

• accumulation of B2 microglobulin
• carpal tunnel syndrome, arthralgia