CKD

Question 1

Define CKD

Answer 1

Reduction in GFR OR structural abnormality OR both 
\+
Present for 3mnths+
\+ 
Assoc. health implications

Question 2

CKD should only be diagnosed in people with ‘markers of kidney damage’. The acronym THE ASS can be used to remember them. Write it out

Answer 2

Transplant
Histological abnormalities on kidney biopsy
Electrolyte abnormalities due to tubular disorders

ACR (urinary albumin:creatinine ratio) greater than 3mg/nmol
Sediment abnormalities in urine (haematuria/casts)
Structural abnormalities by imaging

AND/OR

Persistent reduction eGFR <60

Question 3

What are the two things that the stages of CKD are based on?

The stages are split into G1-G5 and A1-A3. What is worse?

Answer 3

GFR + Urinary ACR (albumin:creatinine ratio)

G5 A3

Question 4

What is the main cause of CKD?

Answer 4

Diabetes

- followed by HTN

Question 5

As a complication of CKD patients may struggle with renal anaemia. Why does this occur?

How is it managed?

Answer 5

Caused by a decrease in erythropoietin

1. Oral iron (ferrous fumarate) - if not tolerated can get IV iron

If adequate iron stores and still not recovering give exogenous erythropoietin simulating agents

Question 6

What is the main message when managing CKD?

Answer 6

TREAT THE UNDERLYING CAUSE

Question 7

What drugs are used to manage mineral bone disorder in CKD?

Answer 7

1. Calcium based phosphate binders - calcium acetate
   - if above causing hypercalcaemia/vascular calcification
2. Sevelamer - non-calcium based phosphate binder

Calcitiriol meds - alfacalcidol

Question 8

What symptoms would a patient with CKD have compared to AKI?

Answer 8

AKI will be a much more acute picture than CKD

CKD more likely to present with anaemia, puritits and weight loss

AKI

• oliguria (abnornomally little urine)
• vomiting and nausea
• dehydration
• oedema

Question 9

How long must the symptoms be present for for it to be diagnosed?

Answer 9

3 MONTHS

Question 10

Explain how CKD related bone disease occurs

Answer 10

CKD causes:
Reduced Vit D (due to reduced activation)
Increased PO4- (as less excreted)

This leads to secondary hyperparathyroidism and increased levels of PO4- cause calcium to be drawn from bones