Chronic Kidney Disease

Question 1

What is chronic kidney disease?

Answer 1

Reduction in kidney function that is permeant and progressive

Question 2

What are the 2 main characteristics of chronic kidney disease?

Answer 2

Impaired renal function for more than 3 months

GFR <60ml/min/1.73m2 for more than 3 months

Question 3

What are the main risk factors of chronic kidney disease?

Answer 3

• Diabetes
• Hypertension
• Smoking
• Chronic use of NSAID’s

Question 4

What are the main causes of chronic kidney disease?

Answer 4

• Hypertensive renal vascular disease
• Diabetic nephropathy
• Glomerulonephritis
• Polycystic kidney disease

Question 5

What is the main cause of chronic kidney disease?

Answer 5

Diabetic nephropathy

Question 6

How does polycystic kidney disease present?

Answer 6

Bilateral flank mass which are ballotable and don’t move with respiration

Question 7

When do symptoms of chronic kidney disease present?

Answer 7

Stage 4

Question 8

How many stages of chronic kidney disease are there?

Answer 8

6 stages (stage 3a and 3b)

Question 9

What are the stages of chronic kidney disease based on?

Answer 9

GFR

Question 10

What is stage 1 GFR?

Answer 10

More than 90

Question 11

What is stage 2 GFR?

Answer 11

60-89

Question 12

What is stage 3a GFR?

Answer 12

45-59

Question 13

What is stage 3b GFR?

Answer 13

30-44

Question 14

What is stage 4 GFR?

Answer 14

15-29

Question 15

What is stage 5 GFR?

Answer 15

Less than 15

Question 16

How does chronic kidney disease present?

Answer 16

• Hypertension
• Loss of appetite
• Itching (urea)
• Pallor (anaemia)
• Restless legs
• Peripheral/pulmonary oedema (fluid overload)
• Bone pain (metabolic bone disease)

Question 17

How is proteinuria diagnosed?

Answer 17

Albumin: Creatinine ratio >3

Question 18

How is chronic kidney disease diagnosed?

Answer 18

GFR

Proteinuria

Question 19

How is GFR diagnosed?

Answer 19

2 tests 3 months apart

Question 20

What is chronic kidney disease the most common cause of?

Answer 20

Normocytic anaemia

Question 21

What 2 electrolyte disturbances can chronic kidney disease cause?

Answer 21

Hyperkalaemia
hypocalcaemia
Hyperphophataemia

Question 22

What are the complications of chronic kidney disease?

Answer 22

Waste excretion - Uraemia and hyperphosphataemia
Regulation of fluid balance - Hypertension and peripheral/pulmonary oedema.
Acid-base balance - Metabolic acidosis.
Erythropoietin production - Anaemia.
Activation of vitamin D - Hypocalcaemia.

Question 23

When would someone with a GFR of 60 not be diagnosed with CKD?

Answer 23

If their albumin creatinine ratio was normal- so no proteinurina

Question 24

What can the electrolyte disturbances lead to?

Answer 24

Secondary hyperparathyroidism

Low calciuma nd high phosphate triggers PTH

Question 25

What nephrotoxic drug can cause chronic kidney disease?

Answer 25

Naproxen

Question 26

When would someone with a GFR of 60 be diagnosed with CKD?

Answer 26

Biopsy proven chronic glomerulonephritis

Question 27

What is the medical management of raised albumin/creatinine with CKD?

Answer 27

ACE inhibitor e.g. ramipril

Question 28

What would you give to someone with CKD and a raised blood pressure?

Answer 28

Start atorvastatin

Question 29

What would you give to someone with CKD and a history of fractures?

Answer 29

Alendronic

Question 30

What is the management of the oedema?

Answer 30

Fluid and salt restriction | Diuretics- Furosemide

Question 31

What is the management of anaemia?

Answer 31

Monthly subcutaneous erythropoietin (with target haemoglobin of 10-12 g/dL). If there is iron deficiency correct it first

Question 32

What is the management of hypocalcaemia and hyperphosphotaemia?

Answer 32

Restrict dietary potassium Prescribe sevelamer- a phosphate binder Prescribe alfacalcidol- a 1-hydroxylated vitamin D analogue

Question 33

When would you carry out a parathyroidectomy?

Answer 33

Tertiary hyperparathyroidism (PTH >28 mmol/L).

Question 34

What is the most common cause of death in someone with CKD?

Answer 34

Cardiovascular disease

Question 35

What are the features of renal osteodystrophy?

Answer 35

Reduced bone density (Osteoporosis) Reduced bone mineralisation (Osteomalcia) Secondary/Tertiary Hyperparathyroidism

Question 36

How would the kidneys appear on a USS of someone with CKD?

Answer 36

Bilaterally smaller kidneys

Question 37

What are exceptiosn when the kidneys appear larger rather than smaller in someone with CKD?

Answer 37

Inital stage of diabetic nephropathy HIV associated

Question 38

What medication should all patients with CKD be started on?

Answer 38

Atorvostatin (Statin)

Question 39

What might indicate CKD rather than an AKI?

Answer 39

Hypocalcaemia

Question 40

How can hyperphophataemia be managed in someone with CKD?

Answer 40

Low phosphate diet Phosphate binders if diet doesn't reduce phosphate levels- calcium acetate or

Question 41

What symptoms can anaemia in CKD present with?

Answer 41

Aortic flow murmur- Soft ejection systolic murmur Tachycardia Fatigue Pallor