19 - CKD

Question 1

What is adult polycystic kidney disease?

Answer 1

• Autosomal dominant with PKD 1 or 2 gene mutation (1 causing earlier disease)
• Cysts grow with age and diagnosed on ultrasound. Kidneys enlarge and decline in function
• Prognosis depends on rate of increase in kidney size

Question 2

What are some secondary complications of APCKD?

Answer 2

• Pain, bleeding in cyst, infection, renal stones (stasis)
• Hypertension
• Intracranial aneurysms
• Heart valve abnormalities

Question 3

How is APCKD managed?

Answer 3

• Treat hypertension by blocking RAAS
• Low salt diet
• Lots of fluids
• Tolvaptan

Question 4

What is the definition of chronic kidney disease?

Answer 4

• Progressive and irreversible loss of renal function over a period of years to months. Functioning renal tissue is replaced by extracellular matrix giving rise to glomerulosclerosis and tubular interstitial fibrosis
• Loss of excretory and endocrine function of kidney

Question 5

Why is CKD hard to define and what is the prevalence in the UK?

Answer 5

• Usually asymptomatic or just proteinuria/hypertension
• 6.1% of the population had CKD in 2001 in the UK. Worldwide 11-13% most in stage 3

Question 6

What are the common causes of CKD?

Answer 6

• Diabetes (most common)
• Hypertension
• Arteriopathic renal disease
• Immunologic e.g glomerulonephritis
• Infection e.g pyelonephritis
• Myeloma, lupus
• Genetics e.g PKCD or history of kidney disease

Question 7

What are some risk factors of developing CKD?

Answer 7

• Hyperlipidaemia
• Proteinuria
• Any form of AKI

Question 8

What are some effects that CKD has on the body, e.g haemotologic and CNS?

Answer 8

Question 9

What are some of the symptoms of CKD?

Answer 9

• Tiredness
• Breathlessness
• Restless legs
• Sleep reversal
• Aches and pains
• Itching
• Chest pain
• Seizures

Question 10

How do we treat end stage renal disease?

Answer 10

• Lower life expectancy and quality of life
• Transplant
• Nocturnal HD comes close

Question 11

What are the advantages and disadvantages of peritoneal and haemodialysis?

Answer 11

Question 12

What are the advantages and disadvantages of having a kidney transplant to treat CKD?

Answer 12

• Better quality of life
• Malignancy and infection risk

Question 13

What are the different stages of CKD?

Answer 13

Question 14

What groups is CKD more common in?

Answer 14

• Elderly
• Multimorbidities
• Ethnic minorities
• Social deprivation

Question 15

What are the first things you should measure if you suspect CKD?

Answer 15

• Also measure creatinine and eGFR
• eGFR measures CKD, creatinine AKI

Question 16

What investigations should you do into CKD?

Answer 16

• Blood tests e.g U and Es, CRP, PTH, iron levels
• Antibody levels for different diseases

Question 17

How can we prevent the progression of CKD?

Answer 17

• Lifestyle
• Stop smoking
• Obesity lose weight
• Exercise
• Control diabetes and hypertension

Question 18

How can we stop someone with CKD being hypertensive, and why are they hypertensive?

Answer 18

• They retain Na and fluid
• Fluid restrict
• Diuretics
• Antihypertensives

Question 19

At what point in CKD do we get hyperkalaemia and how do we manage this?

Answer 19

• When eGFR goes below 20 mls/min
• Stop ACE inhibitors
• Avoid drugs that increase K+ e.g amilioride
• Avoid foods high in potassium

Question 20

How do we treat metabolic acidosis in CKD?

Answer 20

Question 21

Why do you get anaemia in CKD and how do you fix this?

Answer 21

• Check iron stores and replace them orally or IV
• If iron stores fine give EPO

Question 22

Why do you get bone disease in CKD and how can this be managed?

Answer 22

• Get thin bones and bony deposits
• Reduce phosphate intake, take phosphate bindes

Question 23

What can happen to drug metabolism in CKD?

Answer 23

• Reduced metabolism and excretion so need to alter dose
• Side effects more likely, e.g statins

Question 24

What is the definition of end stage established renal failure?

Answer 24

• When death is likely without renal replacement therapy
• eGFR< 15 mls/min

Question 25

When should you consider renal replacement therapy?

Answer 25

- eGFR \<15mls/min or symptomatic

Question 26

What are some of the risk factors of acute tubular injury?

Answer 26

Hypotension, obstetric complications, obstructive jaundice, sepsis, medications, toxins