CKD

Question 1

CKD describes a chronic reduction in kidney function sustained over how long?

Answer 1

3 months

Question 2

What factors may speed up the decline of kidney function?

Answer 2

Diabetes
Hypertension
Medications (NSAIDs, lithium)
Glomerulonephritis
Polycystic kidney disease

Question 3

How do patients with CKD present?

Answer 3

Most are asymptomatic.
May have:
Fatigue
Anaemia and pallor
Proteinuria causing foamy urine
Nausea
Loss of appetite
Pruritis
Oedema
Hyeprtension
Peripheral neuropathy

Question 4

What is the eGFR and what is it based on?

Answer 4

The estimated glomerular filtration rate estimates teh rate at which fluid is filtered from the blood into the Bowman’s capsule and is based on the serum creatinine, age and gender.

Question 5

How is the extent of proteinuria quantified?

Answer 5

The urine albumin:creatinine ratio (ACR)

Question 6

How is blood in the urine assessed?

Answer 6

Urine dipstick or microscopy.

Question 7

What does microscopic haematuria refer to?

Answer 7

When blood is identified on testing but not visible on inspection

Question 8

What does macroscopic haematuria refer to?

Answer 8

When the blood in urine is visible

Question 9

What can haematuria indicate?

Answer 9

Infection
Malignancy
Glomerulonephritis
Kidney stones

Question 10

Other than eGFR, albumin:creatinine ratio, urine dipstick and renal USS, what investigations may be done for CKD?

Answer 10

Blood pressure
HbA1c
Lipid profile (for hypercholesterolaemia)

Question 11

CKD can be diagnosed if over 3 months the eGFR is consistently below what value?

Answer 11

60ml/min/1.73m^2

Question 12

CKD can be diagnosed if over 3 months the ACR (abumin:creatinine ratio) is consistently above what value?

Answer 12

3 mg/mmol

Question 13

CKD is classified by the G score which is based on the _____ and the A score which is based on the ___

Answer 13

eGFR
ACR

Question 14

How many G stages in CKD are there?

Answer 14

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

Question 15

How many A stages in CKD are there?

Answer 15

A1 (ACR is <3 mg/mmol)
A2 (3-30)
A3 (Above 30)

Question 16

What does accelerated progression of CKD refer to?

Answer 16

A sustained decline in the eGFR of 25% or 15 ml/min/1.73 m^2 within one year

Question 17

What are complications of CKD?

Answer 17

Anaemia
Renal bone disease
CVD
Peripheral neuropathy
End-stage kidney disease
Dialysis-related complications

Question 18

What is the Kidney Failure Risk Equation?

Answer 18

Estimation of the 5-year risk of kidney failure requiring dialysis

Question 19

There should be a referral to a renal specialist if the eGFR is less than…

Answer 19

30ml/min/1.73 m^2

Question 20

There should be a referral to a renal specialist if the urine ACR is more than…

Answer 20

70mg/mmol

Question 21

There should be a referral to a renal specialist if the 5 year risk of requiring dialysis is over what percentage?

Answer 21

> 5%

Question 22

There should be a referral to a renal specialist if there is uncontrolled hypertension despite at least _ antihypertensives.

Answer 22

4

Question 23

What is the blood pressure target for CKD patients aged under 80 with an ACR above 70,g/mmol?

Answer 23

130/80

Question 24

What medications can help to slow the progression of CKD?

Answer 24

ACE inhibitors (or ARBs)
SGLT-2 inhibitors (dapagliflozin)

Question 25

What can be done to reduce the risk of complications in CKD?

Answer 25

Exercise Maintain a healthy weight Avoid smoking Atorvastatin 20mg for primary prevention of CVD (in all patients with CKD)

Question 26

What meds can be give to treat anaemia in patients with CKD?

Answer 26

Iron and erythropoietin

Question 27

What meds can be give to treat metabolic acidosis in patients with CKD?

Answer 27

Oral sodium bicarbonate

Question 28

What meds can be give to treat renal bone disease in patients with CKD?

Answer 28

Vitamin D, low phosphate diet and phosphate binders

Question 29

What does management of end-stage renal disease involve?

Answer 29

Special dietary advice Dialysis Renal transplant

Question 30

Both CKD and ACE inhibitors can cause...

Answer 30

hyperkalaemia

Question 31

Healthy kidneys produce what hormone that stimulates the production of RBCs?

Answer 31

Erythropoietin

Question 32

What type of anaemia can CKD cause?

Answer 32

Normocytic, normochromic anaemia

Question 33

What 3 things does renal bone disease involve (think electrolytes)?

Answer 33

High serum phosphate Low vitamin D activity Low serum calcium

Question 34

The kidneys metabolise vitamin D into it's active form which is essential in the intestines for ____ _________ and in the kidneys for ______ ______?

Answer 34

Calcium absorption Calcium reabsorption

Question 35

Active vitamin D also regulating bone turnover and promoting bone reabsorption to increase the serum _____ level

Answer 35

calcium

Question 36

CKD leads to reduced vitamin D activity and __ serum calcium

Answer 36

low

Question 37

What reacts to the low serum calcium and high serum phosphate in CKD?

Answer 37

The parathyroid glands, secrete more parathyroid hormone (secondary hyperparathyroidism)

Question 38

What does parathyroid hormone do?

Answer 38

Stimulates osteoclast activity increasing calcium absorption from bone

Question 39

What can occur due to increased turnover of bones without adequate calcium supply often in CKD?

Answer 39

Osteomalacia

Question 40

What occurs when osteoblasts respond to increased calcium absorption from bone in CKD?

Answer 40

osteosclerosis The osteoblasts increase their activity to match the osteoclasts, creating new tissue in the bone. However the low calcium level means this new bone is not properly mineralised.

Question 41

What is a characteristic finding on a spinal x-ray in renal bone disease?

Answer 41

Rugger jersey spine Sclerosis of both ends of each vertebral body and osteomalacia in the centre (like stripes found on a rugby shirt)

Question 42

How is renal bone disease managed?

Answer 42

Low phosphate diet Phosphate binders Active forms of Vitamin D (calcitriol) Ensuring adequate calcium intake.