Urinary: Chronic Kidney Failure

Question 1

What is chronic kidney disease?

Answer 1

The irreversible and progressive loss of renal function

The injury causes renal tissue to be replaced by extracellular matrix

Question 2

What are the causes of chronic kidney disease?

Answer 2

• most commonly idiopathic
• systemic disease eg diabetes
• hypertension
• obstruction and reflux nephrology
• infection eg pyelonephritis
• genetic
• glomerulonephritis
• athersclerotic vascular disease

Question 3

How does a kidney with CKD look different to a normal kidney?

Answer 3

Kidney is shrunken with an irregular outline

There is a decrease in cortical thickness

Question 4

Which pt groups is chronic kidney disease more common in?

Answer 4

• elderly
• multi morbid
• ethnic minorities
• socially disadvantaged

Question 5

How is chronic kidney disease staged?

Answer 5

Staged from 1-5 depending on GFR
GFRs above 60 are inaccurate so stage 1 and 2 need further diagnostic criteria

Given an ACR category depending on the urine albumin creatinine ratio

Question 6

How common is CKD?

Answer 6

7% of the population have stage 1 2 or 3 (out of 5) chronic kidney disease

Question 7

How can the rate of disease progression be slowed?

Answer 7

Small interventions such as treating BP and dealing with modifiable risk factors can change the need for dialysis in later life

Question 8

At what stage of GFR does mortality start to increase?

Answer 8

When GFR falls by 25% of the normal (so roughly 75ml/min)

Question 9

What bedside measurements should be monitored in pts with CKD?

Answer 9

Blood pressure
Urine dip stick - for protein or blood in the urine (proteinuria predicts the development of end stage renal disease so more likely to need dialysis and die of cardiovascular disease)

Question 10

How can proteinuria be treated?

Answer 10

Treat the BP and use ACEI

Question 11

What are the ways we can measure renal function?

Answer 11

Serum creatinine is used to estimate GFR

Can also measure GFR directly via inulin clearance or creatinine clearance but these are not clinically practical

Question 12

Why is it important to calculate eGFR from the serum creatinine values?

Answer 12

The relationship between serum creatinine and GFR is not linear therefore creatinine can be normal despite having a GFR as low as 40
This is because creatinine is not only determined by renal function but also muscle mass (age,sex,race)

Question 13

What examinations can be done to identify a cause of CKD?

Answer 13

USS to look for size and hydronephrosis (dilated pelvicalyceal system)
CTI, MRI
(if kidneys normal size and cause not obvious renal biopsy may be considered)

Question 14

What are the complications of CKD?

Answer 14

• *Acidosis - treat with oral NaHCO3- tablets
• *Anaemia - the kidneys usually make erythropoietin which controls RBC production, also there is decreased RBC survival and blood loss. Can now administer subcutaneous erythropoietin
• *Metabolic bone disease - There is decreased GFR therefore decreased activation of Vit D, also increase in phosphate so decrease calcium, all lead to increased PTH

Question 15

What are some ways to help prevent or delay progression?

Answer 15

Lifestyle: obesity, smoking, lack of exercise
Treat diabetes and blood pressure
Give ACEI
Give statins

Question 16

What are the different types of renal replacement therapy?

Answer 16

Dialysis (haemo and peritoneal)

Renal transplantation