CKD

Question 1

what imaging can differentiate CKD from AKI

Answer 1

USS - CKD small bilateral kidneys

Question 2

what CKD’s may not have small kidneys on USS

Answer 2

ADPKD, diabetic nephropathy, amyloidosis, HIV

Question 3

what bloods can indicate CKD>AKI

Answer 3

hypocalcaemia

Question 4

causes of CKD

Answer 4

diabetes, HTN, glomerulonephritis, pyelonephritis, PKD

Question 5

features CKD

Answer 5

oedema, polyuria, tired, itch (uraemia) flap (uraemia), anorexia, insomnia, N+V, hypertension

Question 6

what formula is used to calculate eGFR + what variables are there

Answer 6

Modified Diet Renal Disease // serum creatinine, age, gender, ethnicity

Question 7

what factors can affect eGFR variables

Answer 7

pregnant, muscle mass (amputee, body builder), eating red meat <12 hours before

Question 8

what eGFR shows now CKD

Answer 8

60-90+ and all other tests are normal ie no sign of kidney damage

Question 9

eGFR CKD1

Answer 9

> 90 ml and signs of kidney damage

Question 10

eGFR CKD2

Answer 10

60-90 ml + signs of kidney damage

Question 11

eGFR CKD 3

Answer 11

3a = 45-59 // 3b = 30-44

Question 12

eGFR CKD 4

Answer 12

15-29

Question 13

eGFR CKD5

Answer 13

<15

Question 14

how is protienuria monitored in CKD

Answer 14

albumin:creatinine (ACR)

Question 15

what ACR indicates proteinuria

Answer 15

3 mg/mmol

Question 16

how is ACR measured

Answer 16

first pass morning urine // if between 3-70 mg/mmol repeat again to confirm // if 70+ no repeat needed

Question 17

what mx for proteinuria in CKD + when is it indicated

Answer 17

ACEi // if ACR >30 + HTN // if ACR >70 use regardless of BP

Question 18

how long should AKI be monitored to make sure it doesn’t progress to CKD

Answer 18

2-3 years

Question 19

1st line mx for HTN in CKD

Answer 19

ACEi

Question 20

what change in eGFR and creatinine is acceptable after starting mx for HTN in CKD

Answer 20

decrease in eGFR of 25% // rise in creatinine of 30%

Question 21

what antihypertensive should be considered in CKD if eGFR <45

Answer 21

furosemide

Question 22

how does anaemia develop in CKD + at what GFR

Answer 22

decreased EPO // <35

Question 23

what type of anaemia is present from CKD

Answer 23

normocytic anaemia

Question 24

what cardiac comorbidity does CKD anaemia increase risk of

Answer 24

left ventricular hypertrophy

Question 25

target hb anaemia CKD

Answer 25

10-12

Question 26

what needs to be corrected before staring mx in anaemia CKD

Answer 26

1) check iron levels + correct // if 3 months then IV iron

Question 27

mx anaemia CKD

Answer 27

rythropoiesis-stimulating agents (ESAs) eg EPO or darbepoetin

Question 28

what is the kidneys role in vit D

Answer 28

converts it to it’s active form

Question 29

bloods seen in bone disease CKD

Answer 29

low vit D + Ca // high phosphate

Question 30

vit D’s affect on calcium

Answer 30

increase intestinal absorption // increase reabsorption from kidneys (+ phospate)

Question 31

what endocrine disorder can come from bone disease in CKD

Answer 31

secondary hyperparathyoid (from low Ca, vit D + high phosphate)

Question 32

symptoms bone disease CKD

Answer 32

calcification, fractures, ostomalaceia, osteoporosis

Question 33

CKD affect on phosphate

Answer 33

increase as kidneys usually excrete phosphate

Question 34

how does high phosphate affect Ca

Answer 34

‘drags’ Ca from bones –> osteomalacia

Question 35

1st line mx bone disease CKD –> secondary

Answer 35

1 = reduce dietary intake // phosphate binders // vit D // parathyroidectomy

Question 36

problems taking calcium-binders for phosphate inCKD

Answer 36

hypercalcaemia –> calcification