SM 206: Clinical CKD

Question 1

CKD Staging: How many stages, who is at highest risk of complications?

Answer 1

5 stages based on GFR and albuminuria

Stages 3-5 have highest risk of complications

Question 2

How does CKD cause Mineral Bone Disease

Answer 2

High FGF23 production causes less P reabsorption, less vitamin D, more PTH

Leads to vitamin D Deficiency, Secondary Hyperparathyroidism (High PTH and High Ca because vitamin D deficiency disinhibits PTH)

Question 3

How does CKD cause anemia?

Answer 3

Reduced renal clearance and activation activate HEPCIDIN - blocks ferroportin - iron can’t get absorbed from gut or released from spleen - iron-deficient anemia

Question 4

What are the effects of PTH on Calcium, P, vitamin D, FGF23?

Answer 4

PTH = causes hypercalcemia, hypophosphatemia, more vit D activation, more FGF23

Question 5

What methods are used to treat Diabetes mellitus as it causes CKD? How does DM cause CKD?

Answer 5

Glomerular Hyperfiltration through increased glucose load

1. ACEi/ARB: reduce elevated GFR to prevent DM/CKD progression (less Ang II = less EA VC = less GFR)
2. SGLT2i: block Na/Glucose Symporter = more Na in macula densa = Less AA VD = lower GFR

Question 6

What are the acute indications for starting dialysis in a CKD patient?

Answer 6

A - acidosis
E - electrolytes (hyperkalemia)
I - ingestions (ASA, Li+)
O - overload (volume overload)
U - uremia (either in pericardial rub, or symptomatic)