CKD

Question 1

Definition of CKD

Answer 1

Reduction of kidney function or structural damage for more than 3 months with associated health implications

Question 2

Causes of CKD - 8

Answer 2

• Conditions associated with kidney damage - HTN, DM, Glomerular disease
• History of AKI
• Nephrotoxic drugs : ACEis, bisphosphonates, caluneurin inhibitors, diuretics, lithium, NSAIDs, aminoglycosides
• Conditions associated with obstructive uropathy e.g. recurrent calculi, BPH, renal tract disease
• Multisystem diseases that can have renal involvement - SLE, vasculitis, myeloma
• FH of CKD or PCKD
• CVS disease
• Gout

Question 3

Complications of CKD - 7

Answer 3

• CKD
• HTN or dysipidaemia
• CVS disease such as IHD, peripheral arterial disease, HF, stroke
• Renal anaemia
• Malnutrition
• Mineral and bone disorders
• Peripheral neuropathy and myelopathy

Question 4

When to suspect CKD - 4

Answer 4

• if they have any of the risk factors
• raised serum creatinine or lowered eGFR
• Proteinuria
• Persistant haematuria

Question 5

Presentation of CKD - 9

Answer 5

• lethargy
• itching
• cramps
• sleep disturbance
• bone pain
• loss of appetite
• weight loss
• taste disturbance
• polyuria, oligouria, nocturia or anuria

Question 6

Examination findings for CKD - 8

Answer 6

• ammonia smell on breath
• pallor
• cachexia
• cognitive impairment
• tachypnoea
• HTN
• Bilateral flank masses
• peripheral oedema

Question 7

Investigations of CKD

Answer 7

• Serum creatinine and eGFR
• urine sample to measure albumin : creatinine ratio to test for proteinuria
• Arrange a urine dipstick to test for haematura
• Renal ultrasound - looks at renal size, texure, hydronephrosis and structural kidney disease

Question 8

What advice should pts be given about serum creatinine blood test and eGFR testing

Answer 8

Do not eat meat for at least 12 hours before

Question 9

Which markers are used to classify CKD

Answer 9

eGFR (will be decreased)
urinary albumin:creatinine ratio (will be increased)

Question 10

Classification of CKD - eGFR

Answer 10

Stage G1 - >90
Stage G2 - 60-89
Stage G3a - 45-59
Stage G3b - 30-44
Stage G4 - 15-29
Stage G5 - <15

Question 11

Classification of CKD - ACR

Answer 11

A1 - <3
A2 - 3-30
A3 - >30

Question 12

Management of CKD - working to preserve kidney function - 4

Answer 12

• Lifestyle - maintain a healthy weight, no smoking, less alcohol
• Keep blood pressure low
• Review Hba1c in diabetes
• Medication review to discuss nephrotoxic drugs

Question 13

what is the BP target for CKD pts

Answer 13

For pts with ACR <70 - <140/90

For pts with ACR >70 - <130/80

Question 14

How are complications of CKD managed?
Proteinurea, anaemia, mineral bone disorder, fluid overload, acid-base imbalence and CVS disease

Answer 14

Proteinurea - ACEis/ARBs
Anaemia - consider IV iron or EPO
Mineral bone disorder - dietary phosphate restriction, phosphate binders and vit D
Fluid - fluid and salt restriction and diuretics
Acid-Base - oral sodium bicarbonate
CVS - consider statins and anti-platelets as prevention

Question 15

How does CKD lead to Anaemia

Answer 15

Kidney produce EPO, so if kidney function is decreased EPO production is decreased so less RBCs made

Question 16

diagnosis of CKD - 3

Answer 16

For over 3 months:
* ACR over 33
* eGFR below 60
* proteinurea