Chronic kidney Disease

Question 1

When do symptoms in chronic renal failure become apparent ?

Answer 1

Symptoms become apparent urea exceeds 40mM

Question 2

What 2 symptoms do you get when urea >50-60mM ? 😭

Answer 2

Clouding of the mind and myoclonic twitches

Question 3

What are the signs and symptoms of chronic renal failure ?

😭

Answer 3

Oliguria/Anuria and ; 3Cs MAIN 
3Cs: confusion, coma and convulsions 
Malaise and lethargy 
Anorexia and weight loss 
Insomnia 
Nausea and vomiting

Question 4

List the 6 systemic complications that may develop in a patient with longstanding CRF

Answer 4

1. Hypertension and secondary hyperparathyroidism
2. Hypocalcaemia
3. FCP due to uraemia
4. Metabolic acidosis
5. Anaemia (due to decrease in EPO)
6. Cardiac arrhythmia’s

Question 5

Describe the assessment of CKD using GFR

Answer 5

Stage 1: kidney damage with increased or normal GFR>90
Stage 2: kidney damage with mild decrease in GFR 60-89
Stage 3: moderate decrease in GFR 30-59
Stage 3a: GFR 45-59
Stage 3b: GFR 30-44
Stage 4: severe decrease in GFR 15-29
Stage 5: kidney failure:GFR <15

Question 6

List the common causes of CKD

Answer 6

DUG HIPPO
Diabetes
Unknown(idiopathic)
Glomerulonepritis

Hypertension and; Renal artery stenosis 
Intestinal nephritis  
PKD (autosomal dominant)
Pyelonephritis (chronic)
Obstructive uropathy

Question 7

State the 5 investigations used for CKD

Answer 7

Urine, Bloods, basic imaging, advanced imaging and renal biopsy

Question 8

Describe the investigations for CKD done with urine

Answer 8

Urine: urinedipstick MC + S: microscopy
Albumin:creatinine ratio, creatinine:protein ratio

Question 9

Describe the investigations for CKD done with bloods

Answer 9

(6) Blood:
1) FBC (normochromic and normocyctic anaemia)
2. Increase in ESR (vasculitis/SLE)
3. U and Es including decrease in calcium and increase in phosphate
4. Glucose (DM)
5. Increase in PTH if stage 3 CKD
6. Increase in ALP if renal osteodystrophy

Question 10

Describe the investigations for CKD done with basic imaging

Answer 10

Basic imaging: USS to check the normal size and anatomy of the kidneys

Question 11

Describe the investigations for CKD done with advanced imaging

Answer 11

Advanced imaging: CT/MRI

Question 12

Describe the investigations for CKD done with renal biopsy

Answer 12

Renal biopsy done if:
Rapidly progressing
Unclear cause
Normal sized kidneys