CKD and Intro to Renal

Question 1

Common causes of CKD

Answer 1

1. Hypertension
2. Renal vascular disease (renal ischaemia)
3. Diabetes
4. Glomerulonephritis

Question 2

Primary and secondary glomerular disease

Answer 2

Primary

1. Glomerulonephritis (including IgA nephropathy)

Secondary

1. Diabetes
2. Amyloid
3. Haemolytic Uraemic Syndrome
4. Hepatitis B and C
5. Henoch-Schonlein Purpura (HSP)
6. Alport Syndrome

Question 3

Tubulointerstitial disease

Answer 3

1. Drugs
   
   • Sulfur
   • Allopurinol
2. Polycystic Kidney Disease
3. Infection
4. Sarcoidosis
5. Multiple Myeloma

Question 4

Causes urinary tract obstruction

Answer 4

1. Urolithiasis
2. Benign prostatic hypertrophy
3. Tumours
4. Urethral stricture
5. Neurogenic bladder
6. Retroperitoneal fibrosis

Question 5

Vascular disease

Answer 5

• Hypertension
  
  • hypertensive nephrosclerosis
• Renal artery stenosis
• Renal vein thrombosis
• Atheroemboli
• Vasculitis
  
  • ANCA vasculitis (Wegener’s granulomatosis)
  • SLE

Question 6

Stages of chronic kidney disease

Answer 6

GFR over 90mls/min/1.73m2 is normal unless there is other evidence of kidney disease eg. haematuria, proteinuria, structural abnormalities

Stage 1 - Kidney damage with normal GFR (>90ml/min/1.73m2)

Stage 2 - Mild Reduction GFR (60 – 89 ml/min/1.73m2)

Stage 3 - Moderate reduction in GFR (30 – 59 ml/min/1.73m2)

Stage 4 - Severe reduction in GFR (15 – 29 ml/min/1.73m2)

Stage 5 - End Stage Kidney Disease (<15 ml/min/1.73m2)

Question 7

Symptoms and signs of the different stages of CKD

Answer 7

Stages 1 – 3: GFR >30ml/min

• Often no clinical signs or symptoms
• May have nocturia, mild malaise, anorexia in stage 3

Stage 4: GFR<30ml/min

• Added symptoms may include nausea, pruritis, restless legs,
• Clinical evidence of:
  
  • Disturbance of water and electrolytes
  • Metabolic and endocrine abnormalities

Stage 5: GFR<15ml/min or dialysis

• Uraemic manifestations

Question 8

Important past history

Answer 8

1. Hypertension
2. Diabetes
3. Atherosclerosis
4. GN
5. Vasculitis
6. Anaemia
7. Recurrent UTIs – renal scarring

Question 9

Important family history

Answer 9

• Adult polycystic kidney disease - autosomal dominant
• Alport syndrome - X linked
• Familial tendency:
  
  • Hypertension
  • Reflux nephropathy
  • Type 1 diabetes
  • Type 2 diabetes

Question 10

Important drug history

Answer 10

• Effects on drug metabolism and pharmacokinetics/clearance
  
  • Digoxin, Li, opiates
• Alter renal function or may cause renal failure
  
  • In damaged kidneys: ACE inhibitors, diuretics, NSAIDs
• Toxicity to normal kidney
  
  • Aminoglycosides, amphotericin, Li
• Indirectly cause renal failure
  
  • Rhabdomyolysis – IV drug and cocaine users

Question 11

Important social/occupational history

Answer 11

• Organic solvents – Goodpastures syndrome
• Aniline dyes - uroepithelial tumours
• Lead and cadmium – CKD
• Smoking – renal vascular disease
• Alcohol – HTN
• Diet – Na+, protein
• Impact of CKD

Question 12

Sallowed complexion

Answer 12

Impaired excretion urinary pigments (urochromes) & anaemia

Question 13

Hyperventilation/hiccups

Answer 13

Metabolic acidosis

Question 14

Leukonychia causes

Answer 14

• CKD
• Chronic liver disease
• Nephrotic syndrome
• Malabsorption
• Heart failure
• Diabetes

Question 15

Causes of Mees lines

Answer 15

1. Renal failure
2. Arsenic poisoning