CKD

Question 1

Def of CKD?

Answer 1

Kidney damage ≥3mo indicated by ↓ function

Question 2

At which stage does CKD give you symptoms?

Answer 2

Stage 4 (GFR<30)

Question 3

CKD stages?

Answer 3

1 GFR >90
2 GFR 60-89
3a GFR 45-59
3b GFR 30-44
4 GFR 16-29
5 GFR <15

Question 4

Common causes of CKD?

Answer 4

DM

HTN

Question 5

Urine BJP test?

Answer 5

Bence-Jones protein to diagnose and monitor multiple myeloma

Question 6

Renal US results of CKD?

Answer 6

• Usually small (<9cm)

- May be large: polycystic, amyloid

Question 7

Complications of CKD?

Answer 7

CRF HEALS (or ‘O CHARLES’)

• Cardiovascular disease
• Renal osteodystrophy
• Fluid (oedema)
• HTN
• Electrolyte disturbances: K, H
• Anaemia
• Leg restlessness
• Sensory neuropathy

Question 8

Management of renal bone disease?

Answer 8

1. Phosphate binders: sevelamer, calcichew
2. Vit D analogues: alfacalcidol (1 OH-Vit D3)
3. Ca supplements
4. Cinacalcet: Ca mimetic

Question 9

Management of restless leg?

Answer 9

Clonazepam

Question 10

Management of renal caused anaemia?

Answer 10

EPO to raise Hb to 11g/dL (higher = thrombosis risk)

Question 11

Pathophysiology of renal bone disease?

Answer 11

1. ↓ 1α-hydroxylase → ↓ vit D activation → ↓ Ca → ↑ PTH
2. Phosphate retention → ↓ Ca and ↑ PTH (directly)
3. ↑ PTH → activation of osteoclasts ± osteoblasts
4. bone resorption