Condition- CKD

Question 1

What is Chronic Kidney Disease? (CKD)

Answer 1

Progressive loss of kidney function/ loss of GFR <60ml/min/1.73m² for over three months

Question 2

CKD can be divided into 5 stages based on severity. What is stage 1 of CKD?

Answer 2

Stage 1: glomerular filtration rate (GFR) >90 mL/minute/1.73 m², and evidence of kidney damage:

• based on pathological diagnosis
• abnormalities of radiographic imaging
• laboratory findings:
  
  • haematuria
  • proteinuria

Question 3

What are the two main causes of CKD?

Answer 3

1. Diabetes Mellitus
2. Hypertension

Question 4

List some other causes of CKD + Mnemonic to remember it

Answer 4

GOD CHAPS

• Glomerulonephritis
• Obesity
• Diabetes Mellitus + Drugs (NSAIDs)
• CVD
• Hypertension
• Age
• Pyelonephritis, HIV
• Systemic disease (SLE, rheumatoid)

Question 5

Describe the pathological change that occurs to renal tissue post chronic hypertension.

Answer 5

Glomerulosclerosis:

Hypertension => thickened artery walls => hypoperfusion => renal ischaemia => GF secretion => Glomerulosclerosis

Question 6

How does DM cause CKD?

Answer 6

Non-enzymatic glycation of efferent arteriole=> stiffening => blood can’t leave => increased glomerular pressure => glomerulosclerosis

Question 7

List some of the signs and symptoms of uraemia

Answer 7

• Nausea and vomitting + Anorexia
• Encephalopthy
• Asterixis = metabolic acidosis
• Coma and death
• Pericarditis
• Increased bleeding due to decreased platelet adhesion and clotting
• Uraemic frost= skin
• Pruritus

Question 8

List three hormones which may be altered in CKD and state what happens to them

Answer 8

• High Renin => hypertension
• Low Erythropoietin => anaemia
• High PTH => renal osteodystrophy + weak bones

Question 9

What happens to K+, Ca2+ in CKD?

Answer 9

High K+

Low Ca2+ due to failure of kidneys to activate VitD which is needed for calcium absorption

Question 10

List the symtpoms of CKD

Answer 10

• Symptoms of Uraemia: N+V, anorexia, uraemic frost, pruritus, fatigue, pericarditis, bleeding, encephalopathy, confusion + death,
• Symptoms of Hyperkalaemia: cardiac arrhythmias
• Symtpoms of hypokalaemia and secondary hyperparathyroidism: renal osteodystrophy + weak and brittle bones
• Symptoms of anaemia: fatigue
• Symptoms of high renin: hypertension

Question 11

What is the eGFR diagnostic of CKD?

Answer 11

<60

Question 12

Give 4 skin signs of CKD

Answer 12

Pigmentation
Excoriation

Pallor

Purpura

Question 13

Recall 2 autoimmune conditions that can cause CKD and the antibodies you would look for in their serum

Answer 13

SLE- ANA, Anti-dsDNA

Goodpasture’s- Anti-GBM

Question 14

What should you look for in the bloods of someone with CKD?

Answer 14

• Potassium for hyperkalaemia
• Glucose- for undiagnosed diabetes + diabetic control
• FBC: Hb for microcytic anaemia
• Calcium for hypocalcaemia
• Phosphate

Question 15

Which investigation is required for a definitive diagnosis of CKD?

Answer 15

Renal biopsy

Isotopic GFR= GOLD STANDARD but £££

Question 16

Which tests/ findings can help build a pathological picture of Chronic Kidney Disease?

Answer 16

1. Creatinine, GFR estimations
2. Urinalysis- to check for haematuria, proteinuria
3. Renal US/CT/MRI: to find structural abnormalitis
4. Biopsy

Question 17

How does CKD cause anaemia? Watch Osmosis video on it