CKD

Question 1

What is the definition of CKD?

Answer 1

Longstanding progressive impairment in renal function
>3 months evidence of kidney damage
Creatinine from >1.5 times from baseline
Urine output from <0.5mL/kg/h >6h

Question 2

What is the pathology of CKD?

Answer 2

• Kidney damage:
• Proteinuria
• Haematuria
• Anatomical abnormality
• Impaired GFR
• Leads to:
• Fibrosis of tubules, glomeruli and small blood vessels
• Progressive renal scarring
• Classified from stage 1-5

Question 3

What are the risk factors/aetiology of CKD?

Answer 3

• Age
• Diabetes
• Hypertension
• Obesity
• Smoking
• Cardiovascular disease
• Atherosclerotic renal vascular disease
• Schistosomiasis – common in the middle east
• Polycystic kidney disease
• Glomerulonephritis

Question 4

What are the signs/symptoms of CKD?

Answer 4

• Nocturia
• Polyuria
• Oedema
• Pallor
• Lethargy
• Breathlessness of exercise
• Epistaxis
• Bruising
• Pruritus
• Hyperparathyroidism
• Bone pain
• Osteomalacia
• Peripheral paraesthesia and weakness
• Autonomic dysfunction – postural hypotension and disturbed GI motility
• Depressed cerebral function
• Myoclonic twitching and fits
• Median tunnel compression
• Amenorrhoea
• Erectile dysfunction
• Infertility

Question 5

What investigations are conducted for suspected CKD?

Answer 5

FBC
•	↓ RBC
•	↑ ERS
•	U&E’s
•	↑ Urea
•	↑ Creatinine 
•	↑ potassium 
•	↓ HCO3 = metabolic acidosis 
•	↓ Ca
•	↑ phosphate 
•	↓ Vit D
•	↑ PTH
•	↓ eGFR 
•	Urine dipstick 
•	↑ blood 
•	↑ protein
•	US
•	Renal biopsy

Question 6

What are the surgical treatments for CKD?

Answer 6

Dialysis

Question 7

What are the pharmacological treatments for CKD?

Answer 7

• ACE inhibitor/Angiotensin receptor antagonist/Ca channel blocker
• Diuretic
• Statins
• Calcium carbonate – for hyperphosphateaemia
• Vit D
• Recombinant human erythropoietin
• Oral sodium bicarbonate
• Influenza/pneumococcal vaccination

Question 8

What are the non pharmacological treatments for CKD?

Answer 8

• TREAT UNDERLYING CAUSE AND COMPLICATIONS
• Reduce drug doses
• Smoking cessation