S12 CKD

Question 1

What is adult polycystic kidney disease?

Answer 1

Autosomal dominant, mutation in either: PKD 1 gene (85%) or PKD 2 gene.
Cysts can occur in kidneys or liver and grow with age, diagnosed with US.

Question 2

Define CKD?

Answer 2

The irreversible and sometimes progressive loss of renal function over months to years.
Renal injury causes renal tissue to be replaced by
extracellular matrix in response to tissue damage

Question 3

What changes occur to the kidney in CKD?

Answer 3

The kidney becomes shrunken with an irregular outline, histology shows scar tissue, loss of tubules and replacement with fibrous tissue.

Question 4

What are the causes of CKD?

Answer 4

Diabetes, hypertension, genetic (APCKD, Alport’s), infection (pyelonephritis), systemic disease (DM, myeloma).

Question 5

What sign predicts the development of end stage renal disease?

Answer 5

Proteinuria

Question 6

How is renal function measured in CKD?

Answer 6

Measure GFR using inulin or creatinine

Measure serum creatinine and then calculate eGFR

Question 7

What investigations help diagnose CKD?

Answer 7

Blood tests: U+E, LFT, FBC
Imaging: USS (size), CT, MRI (stones)
Biopsy: considered if kidneys normal size and cause of CKD unknown

Question 8

Acidosis is a complication of CKD, describe it

Answer 8

May affect muscle, bone and renal function progression. Treat with oral NaHCO3.

Question 9

Anaemia is a complication of CKD, why does it occur?

Answer 9

Decreased erythropoietin production or resistance to erythropoietin, decreased RBC survival, blood loss. Treat with iron, then EPO injections.

Question 10

Mineral and bone disorders are a complication of CKD, describe what occurs

Answer 10

Abnormal Ca2+/phosphorus metabolism.
Can cause renal osteodystrophy leading to rugger jersey spine

NB kidney usually excretes phosphate but in CKD it accumulates, suppressing Ca

Question 11

What is the effect of CKD on bone?

Answer 11

Decreased GFR causes increased phosphate, which decreases calcium, which increases PTH, which causes osteitis fibrosa cystica.

Decreased GFR decreases amount of active vitamin D, which decreases calcium and increases PTH and also leads to osteomalacia

Question 12

What is the management for the effects of CKD on bone?

Answer 12

Reduce phosphate intake

Question 13

What are the affects of CKD on the kidneys water/salt handling functions?

Answer 13

Reduced GFR so less able to dilute urine

Decreased response to ADH so get osmotic diuresis and nocturia

Question 14

What are the affects of CKD on the kidneys ability to control acid-base disturbances?

Answer 14

Generally asymptomatic but can get oedema, hyperkalaemia, acidosis

Question 15

What are the affects of CKD on the kidneys ability to remove waste products?

Answer 15

Waste products accumulate causing increased urea, nausea, vomiting

Question 16

What are the affects of CKD on the kidneys endocrine functions?

Answer 16

Altered endocrine functions such as RAAS and erythropoietin (causing anaemia)

Question 17

What is end stage renal disease and what are its symptoms?

Answer 17

The final stage of CKD

Tiredness, insomnia, SOB, eGFR <15

Question 18

Why do patients often feel tired in CKD?

Answer 18

Due to less O2 to muscles from anaemia, caused by reduced erythropoietin and increased blood loss

Question 19

What is the management for CKD?

Answer 19

Lifestyle: smoking, obesity, lack of exercise
Treat DM, hypertension
ACEi in proteinuria
Stop PPI

Question 20

What are the three form of renal replacement therapy?

Answer 20

Haemodialysis
Peritoneal dialysis
Kidney transplant

Question 21

What is haemodialysis?

Answer 21

Artery fistula with a vein to make the vein under more pressure, then takes blood to dialyzer.
4 hours, 3 times a week, in hospital

Question 22

What are the pros and cons of hameodialysis?

Answer 22

Pros: less responsibility
Cons: travel time

Question 23

What are the pros and cons of home haemodialysis?

Answer 23

Pros: don’t need to travel away from home
Cons: need someone with you

Question 24

What is peritoneal dialysis?

Answer 24

Waste products cross semi-permeable membrane into peritoneal space, toxins and water absorbed then drained out from peritoneal space into external drainage bag.

Question 25

What are the pros and cons of peritoneal dialysis?

Answer 25

Pros: self-sufficiency
Cons: bag needs frequent/overnight exchanges

Question 26

What are the pros and cons of kidney transplant in CKD?

Answer 26

Pros: decreased mortality and morbidity, better quality of life
Cons: peri-operative risk, infection risk