Week 11 - CKD

Question 1

What is the effect of chronic renal injury on tissue?

Answer 1

-Renal tissue is replaced by extracellular matrix leading to dibrosis and scarring

Question 2

List some hereditary causes of CKD

Answer 2

• PCK

- Alport’s

Question 3

What systemic diseases can lead to CKD?

Answer 3

• Diabetes mellitus

- Myeloma

Question 4

What infection can lead to CKD?

Answer 4

-Pyelonephritis

Question 5

What is the main immunologic cause of CKD?

Answer 5

-Glomerulonephritis

Question 6

What common conditions can lead to CKD?

Answer 6

-Hypertension, diabetes, atherosclerosis

Question 7

Name some risk factors for CKD

Answer 7

• Increasing age
• Ethnicity
• Low socio-economic status

Question 8

What is the aim of treatment for CKD?

Answer 8

-attempt to dcrease the rate of decline of renal function

Question 9

What three things do we measure to monitor CKD?

Answer 9

• Proteinuria
• Serum creatinine
• GFR

Question 10

What is the significance of proteinuria in CKD?

Answer 10

-High proteinuria is associated with steeper decline

Question 11

What determines serum creatinine levels?

Answer 11

-Renal function, muscle mass, age, sex and race

Question 12

What is the difference between GFR and eGFR?

Answer 12

-eGFR tales into account age, sex and race

Question 13

What are the aims of investigation into CKD?

Answer 13

-Define degree of impairment and cause to provide diagnosis and prognosis

Question 14

People with CKD are at higher risk of what type of death?

Answer 14

-Cardiovascular

Question 15

What are the effects of acidosis in CKD?

Answer 15

-Affects muscle, bone and renal function progression

Question 16

What type of anaemia is seen in CKD and why?

Answer 16

-Anaemia of chronic disease and due to decreased EPO production

Question 17

What is renal osteodystrophy?

Answer 17

-Alteration in bone morphology due to abnormalities in Ca, P, PTH or Vit D metabolism

Question 18

Name some effects of renal osteodystrophy which occur in CKD

Answer 18

• Rugger jersey spine
• Osteitis fibrosa cystica
• Calciphalaxis

Question 19

What is calciphylaxis?

Answer 19

-Vascular/soft tissue calcification of the skin leading to small areas of necrosis

Question 20

List some potentially modifiable risk factors for CKD

Answer 20

• Smoking, obesity, lack of exercise

- Diabetes and high blood pressure

Question 21

How do you measure the GFR in a hospital setting?

Answer 21

-Inulin or creatinine clearance

Question 22

What investigations would you do to assess the cause of CKD?

Answer 22

• History and examination
• Autoantibody screen
• CRP
• Imagining of kidneys (USS, CT MRI)

Question 23

What does a USS tell you in CKD?

Answer 23

• Size of kidney

- Presence of hydronephrosis

Question 24

Describe the relationship between GFR and vitamin D

Answer 24

-Decreased GFR limits the delivery of substrate to a1-hydroxylase and thus causes a decrease in active vitamin D production despite PTH levels

Question 25

Describe the indications for dialysis in CKD

Answer 25

• Uraemic symptoms
• Acidosis
• Pericarditis
• Fluid overload
• Hyperkalaemia

Question 26

What is chronic kidney disease?

Answer 26

-The irreversible and sometimes progressive loss of renal function over a period of months to years

Question 27

What are the effects of CKD histiologically?

Answer 27

• Glomerulosclerosis

- Tubular interstitial fibrosis