GU - Chronic Kidney Disease

Question 1

Defintion

Answer 1

Abnormalities of kidney structure or function, present for >3 months, with implications for health

Question 2

Aetiology

Answer 2

• Obstructive uropathy
• Hypoplastic and dysplastic kidneys
• Reflux nephropathy
• Focal segmental glomerulosclerosis
• PKD

Question 3

Signs and symptoms

Answer 3

• Usually ASx until renal function falls < ⅓ of normal, often picked up on antenatal ultrasound
• Anorexia and lethargy
• Polydipsia and polyuria
• Faltering growth
• HTN
• Delayed growth and development

Question 4

Diagnosis

Answer 4

• eGFR:
  = G1 = >90
  = G2 = 60-89
  = G3a = 45-59
  = G3b = 30-44
  = G4 = 15-29
  = G5 = <15
• Proteinuria calculated using the urine albumin: creatinine ratio (ACR). A result of ≥ 3mg/mmol is significant.
• Urine dipstick - Haematuria (significant result is 1+ of blood).
• Renal ultrasound can be used to investigate patients with accelerated CKD, haematuria, family history of polycystic kidney disease or evidence of obstruction.

Question 5

Treatment

Answer 5

• Sufficient feeding with good protein intake to maintain growth -> this can supplemented with NG/gastrostomy feeding if necessary
• Phosphate restriction and activated vit D to prevent renal osteodystrophy
• Bicarbonate supplements to prevent acidosis
• EPO to prevent anaemia
• Growth hormone
• Dialysis and transplantation if necessary