CKD + Hypertension

Question 1

List some Causes/RFs of CKD (Reduced kidney function for >3mths)

Answer 1

• Hypertension, DM, CVD

- AKI, Nephrotoxic drugs, Obstruction

Question 2

List symptoms of CKD

Answer 2

• Difficulty thinking clearly
• Weight/ Appetite loss
• Dry Itchy skin
• Cramps
• Ankle/ Feet Swelling
• Puffiness around eyes
• Polyuria
• Pale due to anaemia
• Nausea + Vomiting

Question 3

List complications of CKD

Answer 3

• Fluid retention
• Uraemia
• Hypertension
• Mineral/bone disorder
• End-Stage Renal Disorder
• Anaemia

Question 4

Suspect CKD if eGFR<60.

List some other investigations

Answer 4

Serum Creatinine, Early morning urine sample for ACR

Dipstick for haematuria
BMI + BP + HbA1c for CVD RFs
Renal USS if needed

Question 5

Outline the monitoring of CKD

Answer 5

• eGFR, ACR
• FBC for Renal anaemia
• Serum Ca/Phosphate/Vit D/ PTH for Renal Metabolic and Bone disorder

Question 6

In what situations would you refer someone with CKD to a specialist

Answer 6

• eGFR<30,
• ACR>69 unless pt has DM
• ACR>29 with persistent haematuria after excluding UTI
• Uncontrolled hypertension
• CKD complication
• Suspected renal artery stenosis

Question 7

Outline the stages of CKD

Answer 7

1: eGFR >89
2: eGFR 60-89
3A: 45-59
3B: 30-44
4: 15-29
5: <15

Question 8

Outline CKD treatment

Answer 8

• If ACR <30, don’t treat for HyperT
• If ACR >29, ACEi or ARB
• If ACR >2 and Diabetic: ACEi or ARB
• If ACR >70, ACEi/ARB + Refer to specialist, unless diabetic
• Renal replacement therapy (Dialysis- Haemo/ Peritoneal)
• Avoid OTC NSAIDs, Protein supplements, Herbal remedies

Question 9

Outline BP targets in CKD

Answer 9

• If ACR<70: S <140, D <90

- If Diabetic/ ACR>69: S <130, D <80

Question 10

How is Accelerated Progression of CKD defined and managed?

Answer 10

• Sustained >25% or >15ml eGFR category chance

- Needs referral after repeating in 2wks to exclude AKI

Question 11

90% of HyperT pts have a Primary cause

When do you consider a 2ndary cause of HyperT

Answer 11

If <40 (Drugs like Steroids, NSAIDs can cause it)

Question 12

What do you do if Clinic BP is over 140/80 or 180/120

Answer 12

Over 140/80;

• Offer ABPM/HBPM
• Investigate organ damage
• Assess QRISK

Over 180/120;

• Repeat BP in 7days
• Investigate organ damage
• Refer for same day specialist review

Question 13

When do you check Sitting + Standing BP?

Answer 13

• DMII
• 80 or over
• Postural HypoT symptoms

Question 14

Outline the 3 stages of HyperT

Answer 14

Stage 1;

• Clinic BP: 140/90 or over
• ABPM/ HBPM: 135/85 or over

Stage 2;

• Clinic: 160/ 100 or over
• ABPM/ HBPM: 150/95 or over

Stage 3;

• Systolic >179
• Diastolic >119

Question 15

What is Accelerated/ Malignant HyperT?

Answer 15

• Severe BP increase to 180/120 or higher

- With signs of Retinal Haemorrhage/ Papilloedema

Question 16

In Pregnancy, outline Hyper T, Severe HT and Chronic HT

BP tends to fall in Trimesters 1 +2

Answer 16

HyperT: Systolic 140-159, Diastolic 90-109

Severe HT: Systolic >159, Diastolic >109

Chronic HT: HT present at/ 20wks before gestation

Question 17

What counts as significant proteinuria in pregnancy?

Answer 17

• PCR of 30/+

- ACR of 8/+

Question 18

Compare Gestational HT, Pre-eclampsia and Eclampsia

Answer 18

Gestational HT: New HT after 20wks gestation without significant proteinuria

Pre-eclampsia: New HT after 20wks gestation with significant proteinuria

Eclampsia: Seizures in a woman with Pre-eclampsia

Question 19

What primary prevention management do you give to someone at high risk of Pre-eclampsia

Answer 19

• Daily Aspirin 75-150mg from 12wks gestation until birth

- BP and dipstick urine at each visit

Question 20

List Pre-eclampsia symptoms

Answer 20

• Severe headache (unrelieved by simple analgesia)
• Visual problems (Blurred, Flashing lights, Diplopia, Floating spots)
• Peristsent new Epigastric pain or RUQ pain
• Vomiting
• SoB
• Sudden swelling of hands/ face/ feet