CKD

Question 1

What is the Definition of CKD?

Answer 1

1. >3months (measured on 2 separate occasions): - eGFR <60L/min/1.73m2 (would recheck in 7 days to rule out AKI)
2. evidence of renal damage (haematuria, microalbuminuria, pathological abnormalities).

Question 2

Screening for CKD?

Answer 2

• only screen at risk populations between 18-30 above 30 screen every 2 years for Aboriginal and every 12months in HTN/diabetes
  
  • ACR (microalbuminuria >2.5M and >3.5F (first thing in the morning))
  • eGFR Can increase due to:
    
    • UTI, f
    • ebrile illness,
    • dietary protein,
    • drugs (NSAIDs),
    • correct eGFR for age using CKD-EPI
  • important to rule out treatable kidney disease:
    
    • UTI
    • Stone
    • Autoimmune
    • Nephrotoxic drugs
    • Kidney cancer

Question 3

What should you do for a CKD management plan?

Answer 3

Management plan:

ST:

• All CKD is treated with ACE I or ARB plus diuretic (avoid NSAIDs and nephrotoxins)
  
  • aim for >50% reduction in ACR
• start a statin
• CKD 1-3 stages reduce daily protein intake 0.75g/kg/day and restrict fluid intake 2-2.5L
• diabetes control <7%HbA1c

MT:

• CVD risk (BP, cholestrol, smoking cessation, glycemic control, decrease weight)
• avoid nephrotoxins
• lifestyle (salt restrict, decrease alcohol, physical activity)

LT:

• review every 12 months with investigations (6mths if microalbumin, 3 months if CKD stage 4 or worse)
• monitor for complications (dose adjust)
• add to recall practice software

If CKD 1-2 then start thinking about RRT:

1. fluid overload (diuretics/dialysis)
2. electrolyte changes (calcium supplements, phosphate binders, resonium/frusemide),
3. dialysis
4. OP/osteomalacia
5. hyperPTH
6. HTN (ACE/ARB)
7. anamia (darbepoetin or iron infusions)

Question 4

What are some RF modifications to stop people getting CKD?

Answer 4

• Obesity (lose weight)
• Diabetes control
• HTN control
• Smoking cessation
• healthy diet
• limit salt intake to <6g per day

Tx BP with ACE I or ARB, use a statin

Prevent children from getting rheumatic fever and prevent pregnancy complications

Question 5

What can cause an elevated urine protein but not an elevated urine albumin?

Answer 5

1. tubulointerstitial disease
2. multiple myeloma

Question 6

Why do you have to repeat CKD test screening? What tool should you use?

Answer 6

• CKD-EPI - measures cerum creatinine and accounts for age/gender
• illness, diet, weight can bias eGFR estimate
• repeat eGFR in 7 days to exclude AKI but also to check the legitimacy of the result.
• should do albumin in the morning, first pass. Repeat 2x in 3 months