Renal 2 - Chronic Kidney Disease

Question 1

causes of CKD

Answer 1

diabetes 
hypertension
ageing decline
glomerulonephritis
polycystic kidneys
medications (NSAIDs, PPI, Li)

Question 2

presentation of CKD

Answer 2

usually on blood, asympto

itching 
loss of appetite
nausea
oedema
muscle cramps
peripheral neuropathy
pallor 
HTN

Question 3

investigating CKD

Answer 3

eGFR (U+Es)
urine albumin:creat ratio
urine dip
renal ultrasound

Question 4

diagnosing CKD

Answer 4

2 eGFR <60 3 months apart
urine ACR >3mg/mmol
blood on urine dip

Question 5

scoring CKD

Answer 5

G score based on eGFR
G5 is end stage <15
G3a is first stage <60

A score based on ACR
A2 >3mg
A3 >30mg

Question 6

complications x 5 of CKD

Answer 6

anaemia
renal bone disease
cardiovascular disease
peripheral neuropathy
dialysis probs

Question 7

when to refer to renal

Answer 7

eGFR <30
ACR >70
acceleration in decrease in function
uncontrolled HTN after 4+ anti HTN meds

Question 8

managing CKD

Answer 8

slow progression - optimise diabetes + BP

reduce complications - lifestyle, special diet, atorvastatin 20mg

treat complications - oral sodium bicarb (acidosis), iron + Epo (anaemia), vit D (bone disease), dialysis (failure), transplant (end stage)

Question 9

treating hypertension in kidney pts

Answer 9

ACE inhibitors

diabetes + raised ACR
any markedly raised ACR

Question 10

treating CKD anaemia

Answer 10

correct iron deficiency with infusion or tablets first

then offer fake Epo

Question 11

renal bone disease summarise incl x3, x ray changes

Answer 11

osteomalacia
osteoporosis
osteosclerosis

rugger jersey spine

Question 12

explain renal bone disease

Answer 12

secondary hyperpara

can’t excrete phosphate
vit D can’t be activated

more PTH released due to low calcium + high phosphate

osteoclasts v active
blasts compensate but can’t mineralise (sclerosis)

Question 13

managing renal bone disease

Answer 13

alfacalcidiol (activated)

low phosphate diet

bisphosphonates if osteoporotic