Renal failure

Question 1

Woman has a GFR or 50. What stage of renal disease does she have?

Answer 1

3a

Classifying renal impariment
Stage 1: >90, normal or inc. GFR with other evidence of renal disease eg. proteinuria/haematuria, abnormal anatomy or systemic disease

Stage 2: 60-89, slightly reduced GFR with other evidence of renal damage

Stage 3a: 45-59, moderately reduced GFR +/- other evidence of renal damage
Stage 3b: 30-44, moderately reduced GFR +/- other evidence of renal damage

Stage 4: 15-29 GFR severely reduced, +/- evidence of renal damage

Stage 5: <15, established renal failure, requires RRT (renal replacement therapy)

Question 2

5 common causes of CKD and 3 rarer ones

Answer 2

Diabetes, 
Glomerulonephritis (commonly IgA nephropathy), 
Unknown
HTN 
Pyelonephritis and reflux nephropathy

Rarer ones:
obstructive uropathy
Chronic interstitial nephritis (myeloma, amyloid)
Adult PKD

Question 3

Which patients are at risk of CKD and should be screened? (aGFR - may underestimate renal function)

Answer 3

Diabetes, HTN,
cardiovascular disease,
structural renal disease (eg. stones/BPH),
recurrent UTIs
Family history of end stage renal failure
Detection of haematuria or proteinuria (opportunistic)

Question 4

What will a CKD patient look like?

Answer 4

Pale,
uraemic tinge (yellowish),
purpura
excoriations (urea = itchy)
signs of incr. BP and fluid overload (ascites, bibasal creps etc)
Cardiomegaly
Cushingoid (steroids)
Gum hypertrophy (ciclosporin)
May have PD catheter or hockey stick scar
AV fistula
Signs of diabetic neuropathy, retinopathy etc

Question 5

When to consider a renal biopsy?

Answer 5

if rapidly progressive disease or unclear cause and normal sized kidneys.

Question 6

Which imaging would you do first to investigate a renal problem?

Answer 6

USS - good for checking size, anatomy and corticomedullary differentiation.

Question 7

What size are kidneys normally in CKD? What might enlarged kidneys suggest?

Answer 7

Generally small (<9cm). Increased in infiltrative ones (eg. amyloid, myeloma), APKD and DM.