HTN, CKD, Hyperlipidaemia

Question 1

Define CKD

Answer 1

A reduction in kidney function and/or structural damage of the kidney. Present for more than 3 months with associated health implications

Question 2

Define HTN

Answer 2

Persistently raised arterial blood pressure. Primary HTN has no identifiable cause. Secondary is due to an underlying cause

Question 3

Define hyperlipidaemia

Answer 3

Have higher levels of LDL cholesterol in the blood, which leads to atherosclerosis and increased risk of CVD. Hyperlipidaemia is also classed as a total cholesterol concentration above 7.5mmol/L and/or FHx, premature CHD.

Question 4

What is the diagnostic criteria for CKD?

Answer 4

1) Risk factors for CKD. 2) Findings of raised serum creat, or eGFR<60ml/min, protein in urine or persistent hematuria. 3)Clinical features of CKD

Question 5

What are RF for CKD?Name 2.

Answer 5

HTN, DM, glomerular disease, AKI, CVD. Use of nephrotoxic drugs eg ACEi, obstructive uropathy (kidney stones), FHx of CKD stage 5, obesity with metabolic syndrome, gout, heamturia, proteinuria

Question 6

What are clinical features of CKD? Name 2.

Answer 6

Lethargy, breathlessness, itch, cramps, bone pain, loss of appetite, Tom, weight loss. Urine output - polyuria, oliguria, nocturia, FHx, autosomal Dom polycystic kidney disease. On examination - pallor, cachexia, cog impairment, dehydration, tachypnoea, HTN, palpable mass in both flanks, palpable distended bladder, peripheral oedema, peripheral neuropathy, frothy urine

Question 7

What is the diagnostic criteria for HTN?

Answer 7

Measure BP. Pt seated, arm outstretched and supported. If BP is 140/90 mmHg, take a second measurement

Question 8

What is the diagnostic criteria for hyperlipidaemia?

Answer 8

Need to baseline blood tests - non fasting blood tests, non fasting lipid profile, LFTs, renal function - eGFR, Hb1Ac, CK, TSH.

Question 9

What does QRISK assess?

Answer 9

Used to assess CVD risk for primary prevention of CVD.

Question 10

What would be in your management plan with a patient with QRISK <10%?

Answer 10

Assess/discuss lifestyle factors that can be improved. Review co-morbidities. Advise risk assessment in 5yrs.

Question 11

What does QRISK of >10% mean?

Answer 11

Risk of CVD is high. E.g. 20% QRISK means there is a 2 in 10 chance of developing CVD within 10years.

Question 12

What measures would you put in place for a patient with QRISK above 10%

Answer 12

Exclude secondary causes of a high lipid profile, discuss lifestyle modifications, start statins - 20mg atorvastatin daily for primary prevention, offer antiHTN tablets.

Question 13

What may be the presenting complaint of a patient with early CKD?

Answer 13

Vague and non-specific symptoms e.g. Tired, little energy, not feeling well.

Question 14

What are signs and symptoms of severe chronic kidney disease?

Answer 14

Hard to concentrate, poor appetite, weight loss, dry, itchy skin, muscle cramps, peripheral oedema, puffy eyes, polyuria, pallor, nausea

Question 15

What risk factors in a Hx may point you towards diagnosing HTN?

Answer 15

Overweight, high salt in diet, high alcohol intake, little sleep, high caffeine intake, little variation in diet, living in a deprived area, smoker

Question 16

What can be seen on clinical examination of someone with hyperlipidaemia?

Answer 16

Corneal arcus, xanthalasma, tendon xanthomata

Question 17

What may be in history of patient with hyperlipidaemia?

Answer 17

FHx, obesity, DM, CVD, poor diet, sedentary lifestyle, smoking, alcohol, male, kidney disease, older age, high cholesterol in blood

Question 18

What lifestyle management would you advise for CKD?

Answer 18

Reduce fluid intake, smoking cessation, obesity advice, avoid nsaids, reduce potssium levels in diet.

Question 19

What immunisations would you suggest to a pt with CKD?

Answer 19

Flu and pneumococcal disease

Question 20

When would you refer a pt with CKD?

Answer 20

Urgent 2ww if have persistent hematuria. If eGFR<30ml, refer if UT obstruction.

Question 21

What lifestyle advice would you advise for HTN?

Answer 21

reduce alcohol, reduce salt, lose weight, increase exercise, cut down caffeine, smoking cessation.

Question 22

What are management steps for HTN?

Answer 22

Step 1:ACEi (if under 55 and not of black/African descent) or ARB. If over 55 and of black/African descent, give CCB. Regardless, if pt has HTN w T2DM = give ACEi/ARB
Step 2: Discuss adherence. Step 1 drug + one of ACEi/ARB/CCB/TLD
Step 3: Review adherence. ACEi/ARB +CCB +TLD
Step 4: Resistant HTN - if K+ is 4.5 or less give Spironolactone. If K+ is 4.5

Question 23

In an annual review of HTN pt, what are you checking?

Answer 23

Lifestyle, meds and monitoring. Check renal function. Check QRISK.

Question 24

What is primary and secondary prevention of hyperlipidaemia?

Answer 24

Primary - 20mg atorvastatin and lifestyle discussion re modifiable risk factors. Secondary - 80mg atorvastatin.

Question 25

What complications can arise from CKD?

Answer 25

HTN, CVD, renal anaemia, renal mineral and bone disorder, peripheral neuropathy and myopathy, ESRD (malnutrition and malignancy)

Question 26

What complications can arise from HTN?

Answer 26

Heart failure, CVD. Coronary artery disease, Stroke, CKD, Peripheral arterial disease, Vascular dementia.

Question 27

What complications can arise from hyperlipidaemia?

Answer 27

Angina, chest pain, MI, stroke.

Question 28

How often is review for someone with QRISK at/above 10%

Answer 28

Annually