CKD

Question 1

What is CKD?

Answer 1

• Progressive deterioration of renal function over months to years
• Usually irreversible
• Deterioration can be slowed with treatment

Question 2

How is CKD measured?

Answer 2

• Estimated GFR (eGFR)

Question 3

Why is CKD irreversible?

Answer 3

• Renal tissue is replaced by extracellular matrix in response to damage

Question 4

What are some risk factors for CKD?

Answer 4

• Type 2 diabetes
• Hypertension
• Renovascular disease

Question 5

Why is type 2 diabetes a risk factor for CKD?

Answer 5

• Efferent arterioles cannot constrict and dilate when BP changes

Question 6

Why is hypertension a risk factor for CKD?

Answer 6

• More pressure on glomerulus
• Regulatory mechanisms for controlling GFR no longer work
• Scarring and damage to fine capillaries
• 80-85% of CKD patients are hypertensive

Question 7

Why is renovascular disease a risk factor for CKD?

Answer 7

• Narrows arteries that supply kidneys

Question 8

How does type 2 diabetes cause hyperfiltration?

Answer 8

• Blood glucose is reabsorbed with Na+
• Less Na+ present at end of PCT
• Due to increased glucose uptake earlier in tubule
• Less Na+ is delivered to macula densa
• Interpreted as low BP
• RAAS is activated
• Increases BP
• More filtration occurs
• Causes damage to capillaries over time

Question 9

How can hypertension be treated?

Answer 9

• Want to treat before kidneys are damaged and progress to end renal failure
• Anti-hypertensives
• Diuretics
• Fluid restriction

Question 10

What is the primary aetiology of CKD?

Answer 10

• Polycystic kidney disease
• Acute tubular necrosis
• Recurrent pyelonephritis
• Glomerulonephritis

Question 11

What is the secondary aetiology of CKD?

Answer 11

• Diabetes mellitus
• HTN
• Reno-vascular disease
• Auto-immune

Question 12

How does CKD affect the structure of the kidney?

Answer 12

• Severe atrophy
• Especially of cortex
• Collecting system is affected less
• Lose functional tissue of kidney

Question 13

Why is HbA1C not a good method of monitoring glucose levels in patients with CKD?

Answer 13

• HbA1C is glycosylated haemoglobin
• Patients with CKD often can’t make erythropoietin
• Less production of RBCs
• Patients are often anaemic
• Fasting plasma glucose better

Question 14

How do you treat patients that are anaemic and have CKD?

Answer 14

• EPO supplements
• Iron supplements

Question 15

If a patient has fluid overload and CKD, how should we treat them?

Answer 15

• Loop diuretics
• Inhibit NKCC co-transporters
• Eliminate large quantities of fluid rapidly
• Use a bigger dose than in a patient without CKD

Question 16

Why might a patient with CKD become acidotic?

Answer 16

• Would be metabolic acidosis
• Kidney can’t preserve bicarbonate
• Give sodium bicarbonate to correct pH of blood

Question 17

Outline calcium homeostasis

Answer 17

• Impaired renal function causes decreased active vit D
• Leads to decreased Ca2+ absorption from gut
• Plasma Ca2+ decreases
• Also leads to decreased PO4 excretion
• Plasma PO4 increases
• Decreased Ca2+ and increased PO4 stimulates parathyroid glands and causes hyperplasia
• Increases bone resorption
• Lack of active vit D impairs bone mineralisation

Question 18

What is uraemia?

Answer 18

• Nitrogenous compounds increase in blood

Question 19

What are some of the symptoms of uraemia?

Answer 19

• Vomiting, nausea, poor appetite
• Dry skin, brittle nails
• Heart failure
• Muscle weakness, bone pain,
• Swelling
• SOB

Question 20

What happens to the functions of the kidneys due to CKD?

Answer 20

• Can’t control acid/base, K+, PO4-, or fluid levels
• Can’t excrete K+, PO4-, creatinine, or urea
• Deranged RAAS
• Decreased EPO and vit D
• Can’t regulate concentration of fat soluble vitamins
• less glucose reabsorbed

Question 21

When do we need to put a patient on renal replacement therapy?

Answer 21

• When renal function declines to a level no ,longer adequate to support health
• eGFR 8-10

Question 22

What are the 3 types of renal replacement therapy?

Answer 22

• Haemodialysis
• Peritoneal dialysis
• Renal transplant

Question 23

What are the pros of haemodialysis?

Answer 23

• Less responsibility
• Days off
• Proven effective long-term

Question 24

What are the cons of haemodialysis?

Answer 24

• Time consuming
• Patient is tied to dialysis times
• Access/line problems
• Fluid/food restrictions

Question 25

How does haemodialysis work?

Answer 25

- Blood is taken from patient - Anti-coagulant is added - Counter-current flow of dialyzer removes waste products - Haemofiltration uses a membrane similar to glomerulus - Blood put back into patient

Question 26

How does peritoneal dialysis work?

Answer 26

- Peritoneum is used as a membrane to dialyse blood

Question 27

What are the pros of peritoneal dialysis?

Answer 27

- Continuously done at home, allows for independence - Less fluid/food restrictions - Easy to travel - Renal function may be better preserved initially

Question 28

What are the cons of peritoneal dialysis?

Answer 28

- Frequent daily exchanges/overnight - Responsibility - Peritonitis - Less long-term survival data

Question 29

What is the gold standard treatment for CKD?

Answer 29

- Renal transplant - Both parties can survive with one kidney