L3 - Chronic Kidney Disease

Question 1

Define Chronic Kidney Disease?

Answer 1

Defined by the presence of markers of kidney damage or decreased kidney function , eGFR<60

Question 2

What is the criteria for CKD?

Answer 2

Either one, both or two criteria for at least 3 months:

1. GFR < 60mL/ min per 1.73m2
2. Markers of Kidney damage

Question 3

State some examples of markers of kidney damage?

Answer 3

• Albuminuria
• Urinary sediment abnormality
• Electrolyte or other abnormality due to tubular disorder
• Abnormalities on histology
• Structural abnormalities detected by imaging
• History of Kidney transplantation

Question 4

A GFR < 15mL/min indicates?

Answer 4

• Severe renal disease.

- Ability to effectively dilute or concentrate urine is lost.

Question 5

Why might anaemia be caused in CKD?

Answer 5

• Deficient erythropoietin production

- due to a reduction of functional renal mass.

Question 6

What is nocturia?

Answer 6

Waking up in the middle of the night because you have to pee.

Question 7

What are examples of some neuromuscular symptoms associated with severe renal disease? (4)

Answer 7

• Coarse muscular twitches
• Peripheral sensory and motor neuropathy
• muscle cramps
• hypereflexia

Question 8

Describe some other symptoms associated with severe renal disease?

loads

Answer 8

• Uremic frost —> uric acid crystals deposited on skin
• yellow/brown skin
• anorexia
• nausea, vomiting
• weight loss
• stomatitis —> inflammation inside mouth
• pruritus —> itching
• unpleasant taste in mouth

Question 9

What is Uremic frost?

Answer 9

• urea from sweat crystallises on skin

Question 10

What is stomatitis?

Answer 10

Inflammation of mouth, lips.

Any inflammatory process affecting mucous membranes of mouth and lips.

Question 11

What is Pruritus?

Answer 11

Severe itching of skin

Question 12

In urinalysis what may be looked at?

loads

Answer 12

Urinary sediment
- e.g. epithelial cells, blood cells, casts

Electrolytes

Urea

Nitrogen

Creatinine

Phosphate

Calcium

Question 13

Why might an ultrasound be useful when diagnosing CKD?

Answer 13

Will help distinguish between acute kidney injury from CKD based on kidney size.

CKD patients tend to have small shrunken kidneys
< 10cm.

Question 14

What is the treatment for CKD?

Answer 14

Controlling underlying disorders and contributing factors.

Restriction of dietary protein, phosphate and potassium.

Vit D supplements

Anaemia

Dialysis if GFR severely low

Question 15

State the stages of CKD?

Answer 15

G1, G2
G3a, G3b
G4
G5

Question 16

Describe stage 1 -2 of Kidney disease?

Answer 16

Presence of markers of kidney damage.

Question 17

Describe stages 3-5 of kidney disease?

Answer 17

GFR < 60
With or without markers of kidney damage.
GFR taken on two separate occasions around 90 days apart.

Question 18

Describe End Stage Kidney disease?

Answer 18

GFR < 15mls/min per 1.73m2

Functions not enough to support life long term.

Question 19

What options are available to a patient suffering from End Stage Kidney disease?

Answer 19

Transplant, dialysis and conservative care

Question 20

Stages of CKD: G1

Answer 20

GFR: > 90

Normal or high

Question 21

Stages of CKD: G2

Answer 21

GFR: 60 - 89

Mildly decreased

Question 22

Stages of CKD: G3a

Answer 22

GFR: 45 - 59

Mildly to moderately decreased.

Question 23

Stages of CKD: G3b

Answer 23

GFR: 30 - 44

Moderately to severely decreased

Question 24

Stages of CKD: G4

Answer 24

GFR: 15 - 29

Severely decreased

Question 25

Stages of CKD: G5

Answer 25

GFR: < 15
Kidney failure
Absolutely fucked

Question 26

Why is it important to detect CKD?

Answer 26

Kidney failure independent risk factor for CV mortality.

14th rank on leading cause of death.

Question 27

Give examples of investigations which may be conducted if CKD is suspected?

Answer 27

1. Tests for determining filtration
2. Urine testing
3. Scanning of Kidneys
4. Kidney biopsy

Question 28

How is urine sediment obtained and what might it show?

Answer 28

Urine is centrifuged.

1. RBC
2. WBC
3. Casts - cylindrical structures that are formed in the tubular lumen.

Question 29

RBC in urine sediment might indicate…

Answer 29

• Kidney stones
• malignancy
• glomerular disease

Question 30

WBCs in urine sediment might indicate…

Answer 30

• Infection
• interstitial nephritis
• renal tuberculosis
• nephrolithiasis

Question 31

What is nephrolithiasis?

Answer 31

Process of forming a kidney stone.

Question 32

What is interstitial nephritis?

Answer 32

Spaces between tubules inside the kidney become inflamed.

- Reduces the kidney’s ability to filter properly.

Question 33

What do casts found in urine sediment represent?

Answer 33

RBC casts - suggest an underlying proliferative glomerulonephritis

WBC casts - indicative of interstitial or less commonly, glomerular inflammation.

Question 34

What are some markers of kidney dysfunction?

Answer 34

1.Reduction in GFR

2. Urine
   - –> blood, protein, casts
3. Scan of kidneys
   - –> small, polycystic, hydronephrosis

Question 35

Hydronephrosis

Answer 35

Swelling of a kidney due to a build up of urine.

Question 36

What tests are used to detect kidney dysfunction?

Answer 36

Creatinine 
eGFR
Creatinine clearance 
GFR measurement 
Cystatin C measurement and Cystatin C eGFR

Question 37

What is cystatin C?

Answer 37

Low-molecular weight protein.
- cystatin superfamily of cysteine protease inhibitors

High level may mean kidneys are malfunctioning.

Question 38

Describe what should happen to cystatin C in the glomerulus?

Answer 38

Normally filtered at glomerulus and not reabsorbed.

- metabolised by tubules