CKD and PKD

Question 1

Causes of CKD?

Answer 1

1) Diabetes
2) Hypertension
3) Other: chronic pylonephritis, glomrulonephritis, PKD, etc

Question 2

Symptoms of CKD?

Answer 2

• Uraemia symptoms: loss of appetite, metallic taste, N&V, pruritus, neuropathy, encephalopathy
• Anaemic symptoms: fatigue, SOB, weakness
• Oedema (cause by sodium retention)
• Metabolic bone disease
• HTN

Question 3

Investigations for CKD?

Answer 3

• Urinalysis: dipstick for haematuirra and proteinuria; urine ACR (significant if >3)
• U&Es to calculate GFR
• ?LFTs for signs of liver cysts if suspect PKD?
• Renal USS (accelerated CKD/haematuria/FMH of PKD/evidence of obstruction)

Question 4

Aims of CKD treatment?

Answer 4

• Slow progression of disease (optimise diabetic and hypertension control)
• Reduce risk of CVD: atorvastatin 20mg
• Reduce risk of complications: lifestyle advice (exercise, stop smoking, advice on dietary sodium, phosphate ,potassium and water)
• Treat complications

Question 5

Treating hypertension in CKD?

Answer 5

• ACEi/ARB
• Criteria: diabetes + ACR >3, hyprtension + ACR >30, any patient with ACR >70
• Need to monitor potassium as ACEi + CKD can cause hyperkalaemia
• If ACR >70 despite maximal ACEi/ARB treatment then start SGLT-2 inhibitor

Question 6

Treating anaemia in CKD?

Answer 6

• Check iron levels before starting treatment (give IV iron if deficient)
• EPO
• Side facts of EPO: flu-like symptoms, bone aches, skin rash, HTN
• Avoid blood transfusions

Question 7

Investigation + treatment of bone disease in CKD?

Answer 7

• Spine X-ray: shot rugger Hersey spine (sclerosis at vertebral edge with osteomalacia in middle)
• Calcium supplements: active vit D (e.g. alfacalcidiol/calcitriol) + oral calcium
• Low phosphate diet or phosphate binders (sevelamer)
• Bisphosphonates for osteoporosis
• Hyperkalaemia: dietary restrictions + furosemide

Question 8

Signs of PKD?

Answer 8

• Signs of chronic kidney disease
• Extra-renal symptoms: cerebral aneurysms, hepatic cysts (most common), mitral regurgitation, colonic diverticula, aortic root dilation

Question 9

Diagnosis of PKD?

Answer 9

• Abdo USS + genetic testing

Question 10

Management of PKD?

Answer 10

• Tolvavaptan to slow cyst progression
• Pther management: HTN, analgesia for (colic, stones & cysts), antibiotics and drainage for cyst infection, dialysis and transplant for ESKD