ICL CKD - Week 7

Question 1

AKI events classified via pre, intra & post.

Answer 1

Pre – drugs
Intra – ACE-I, ARBs, NSAIDs, opioids, diuretics
Post – stones, BPH

Question 2

What is CKD a risk factor for?

Answer 2

Ischaemic heart disease & CVD.

Question 3

SR which should be completed for pts presenting w suspected renal pathology.

Answer 3

• CVS – due to dysregulation of angiotensin-aldosterone system
• Haem – due to dysregulation of EPO
• Genitourinary – due to dysregulation of waste excretion & ion regulation processes -> uncontrolled BP
• Endo – due to dysregulation of vit D regulation etc. -> thyroid pathologies.

Question 4

Define CKD

Answer 4

Condition that progressively damages the kidneys and gradually impairs and leads to a loss of kidney function.

Question 5

Causes of CKD include:

Answer 5

• HBP
• Diabetes
• Alport’s syndromes
• Infection
• Medications/drugs
• Lupus
• Autoimmune conditions
• Heavy metal poisoning…

Question 6

CVD risk factors include

Answer 6

• Diabetes
• High BP
• Heart disease
• Smoking
• Obesity
• FHx
• Kidney abnormalities
• Age
• AKI
• African American, Native American, Asian American ethnicity

Question 7

Development of Autosomal Dominant PKD induced loss of function

Answer 7

Autosomal Dominant PKD – disease where cysts develop on the kidneys -> kidney enlargement -> loss of function.
(Cysts develop from tubular portion of the nephron -> push on healthy nephron vessels -> poor perfusion of healthy nephrons -> enlargement of the kidneys).

Question 8

Causes of Autosomal Dominant PKD

Answer 8

• 2 x different genetic mutations:
• PKD1: severe, early onset
• PKD2: less severe, later onset.

Question 9

Signs & symptoms of PKD

Answer 9

• Flank pain
• Haematuria
• Dysuria
  Lightheadedness/cognitive impairment
  NB: Kidney’s palpable on PE due to enlargement.

Question 10

Complications of PKD

Answer 10

Complications incl:
* Hypertension
* Left ventricular hypertrophy
* Anaemia
* Osteoporosis
* Cognitive impairment
* Diabetes mellitus
* Metabolic acidosis
* Hypercalcaemia
* Oedema
* Cardiac arrhythmias
* Muscle weakness
* Paralysis
* Pericarditis
* GI bleeding
* Infections.

Question 11

Treatment of CKD includes

Answer 11

• Preventative treatment incl. ACE inhibitor OR ARB, statins, diuretics, sodium glucose cotransporter
• End stage treatment incl. EPO stimulating agent, iron supplement, Vit D analogue, phosphate binding agents (i.e., Ca2+) and/or Renal transplant.

Question 12

2 x types of dialysis

Answer 12

• Haemodialysis
• AV fistula – w one needle inserted into artery & one into vein
• Straight graft – radial a -> cubital v
• Loop graft – brachial a -> cubital v
• Peritoneal dialysis.

Question 13

What do high urea or creatinine levels indicate?

Answer 13

Issue w kidney filtration.

Question 14

What do low Hb levels indicate?

Answer 14

Reduced EPO production.

Question 15

What do low EPO levels predispose to?

Answer 15

Iron-deficiency anaemia.

Question 16

What does a low eGFR level indicate?

Answer 16

Kidney disease w lowest levels suggestive of end-stage kidney disease.

Question 17

What do high Ca2+ levels indicate?

Answer 17

Increased Ca2+ demand by the body.

Question 18

What do high blood phosphate levels indicate?

Answer 18

Impaired kidney filtration ability.

Question 19

What MRIs are often ordered for pts diagnosed or suspected with CKD?

Answer 19

Renal & brain MRI.
* Renal MRI – to screen for abscesses, obstructions, tumours, growth, cysts and also allow for assessment of renal blood flow.
* Brain MRI – to screen for brain aneurysm, uraemic encephalopathy.