L13: Chronic Kidney Disease + Nephritic & Nephrotic Syndrome

Question 1

What is chronic kidney disease? (definition + values)

Answer 1

• abnormality in kidney function > 3 months
• eGFR < 60 mL/min/1.73 m^2
• irreversible kidney damage (presents with albuminuria, electrolyte imbalances, reduced production of erythropoietin)

Question 2

Explain the staging/classification system for chronic kidney disease. For each stage, give the specific associated value.

Answer 2

Stage 1 - eGFR > 90 (GFR normal + evidence of kidney damage)

Stage 2 - GFR: 60 - 90 (mild kidney damage)

Stage 3a - GFR: 45 - 59 (mild to moderate kidney damage)

Stage 3b - GFR: 30 - 44 (moderate to severe kidney damage)

Stage 4 - GFR: 15 - 29 (severe kidney damage)

Stage 5 - GFR < 15 (kidney failure)

Question 3

List some risk factors for chronic kidney disease

Answer 3

• hypertension
• diabetes
• atheroma
• old age
• family history
• prolonged hospital admission

high blood pressure will cause damage to the blood vessels in the kidney

Question 4

List the possible causes of chronic kidney disease

Answer 4

• diabetic nephropathy
• hypertensive nephropathy
• glomerulonephritis
• adult polycystic kidney disase
• tubulo-interstitial nephropathy
• obstructive nephropathy
• chronic pyelonephritis

Question 5

What is the most common cause of CKD?

Answer 5

diabetic nephropathy

Question 6

List some complications of CKD

Answer 6

• CKD mineral and bone disorder
• CKD-associated anaemia
• metabolic acidosis
• heart disease

Question 7

Why is anaemia a complication of CKD?

Answer 7

• CKD can cause decreased erythropoietin production

- causes normocytic, normochromic anaemia

Question 8

What does “normocytic normochromic” anaemia

Answer 8

• RBCs have a normal size

- RBCs have a normal colour

Question 9

How does CKD cause CKD mineral and bone disorder? (explain the process)

Answer 9

CKD causes decreased activity of 1-alpha hydroxylase enzyme

• decrease in calcitriol
• results in decrease in Ca2+
• increase in PTH secretion

Result: CKD mineral and bone disorder; renal osteodystrophy; extraosseous calcifications

Question 10

What are the main abnormalities associated with CKD?

Answer 10

• hyperphosphataemia
• hypocalcaemia
• secondary hyperparathyroidism (low Ca2+, high phosphate, low vitamin D)

Question 11

Why is metabolic acidosis a complication of CKD?

Answer 11

failing kidney can’t excrete acid in diet

Question 12

When is dialysis usually started?

Answer 12

• stage 5 CKD typically
• eGFR < 10
• acidosis/hypocalcaemia/hyperphosphataemia

Question 13

What are the 2 types of dialysis?

Answer 13

1. Haemodialysis

2. Peritoneal Dialysis

Question 14

What are the indications for a renal biopsy?

Answer 14

• unexplained proteinuria/nephrotic syndrome
• unexplained AKI
• unexplained CKD
• renal transplant dysfunction
• non-visible haematuria
• familial renal disease

Question 15

List some of the complications of a renal biopsy

Answer 15

• pain
• bleeding (haematuria or perinephric haematoma)
• arteriovenous fistula formation
• damage to surrounding structures

Question 16

Typically, what is the purpose of an arteriovenous fistula?

Answer 16

• surgically created

- provides good flow for dialysis