Chronic Kidney disease

Question 1

What is CKD?

Answer 1

eGFR <60 ml/min/1.73m^2 for 3+ months
Subtle decrease in function

Question 2

What are the stages of eGFR?

Answer 2

1. 90+ with renal signs
2. 60-89 with renal signs
3. A= 45-59
   B= 30-44
4. 25-29
5. <15
   (If 1 and 2 normal, NO CKD)

Question 3

What 4 parameters are used?

Answer 3

Creatinine
Age
gender
ethnicity

Question 4

Clinically, best readings to quantify CKD?

Answer 4

eGFR
ACR (albumin:creatinine) more sensitive measure of proteinuria than PCR

Question 5

RF for CKD?

Answer 5

DM - Excess glucose sticks to proteins, affects efferent arteriole + it becomes stiff and more narrow

Htn - renal artery wall thicken = narrow lumen therefore low BF

Glomeruloneophritis, PKD, Nephrotoxic drugs (NSAIDs)

Question 6

When is Metformin CI?

Answer 6

When eGFR <30

Question 7

Pathology of CKD?

Answer 7

1 million nephrons - In CKD, many damaged resulting in low GFR and increased burden on remaining nephrons

Compensatory RAAS to increase GFR but increased transglomerular pressure = shearing + loss of BM selective permeability = proteinuria/haematuria

Angiotensin 2 upregulates TGF-B and plasminogen inactivator 1 causing mesengial (supportive tissue) scarring

Question 8

Pathology of CKD?

Answer 8

1 million nephrons - In CKD, many damaged resulting in low GFR and increased burden on remaining nephrons

Compensatory RAAS to increase GFR but increased transglomerular pressure = shearing + loss of BM selective permeability = proteinuria/haematuria

Angiotensin 2 upregulates TGF-B and plasminogen inactivator 1 causing mesengial (supportive tissue) scarring

Question 9

Sx?

Answer 9

Early on as aSx (lots of nephrons= reserve supply)
Sx due to substance accumulation + renal damage (diabetic nephropathy)

Question 10

Complications?

Answer 10

Anemia (low EPo)
Osteodystrophy (low vit D activation)
Neuropathy + encephalopathy
CVD (most mortality complication)
Haematuria and proteinuria

Question 11

Dx of CKD?

Answer 11

FBC (Anemia of chronic disease)
U+E
Urine dip (proteinuria)
USS (bilateral renal atrophy)
GFR function 1-5
(albumin:creatinine ratio >3 = significant proteinuria)

Question 12

Tx of CKD?

Answer 12

No cure so treat complications
Anemia = Eso + Fe (first)
Osteodystrophy = Vit D supps
CVD = ACE-I and statins (reduce atherosclerosis)
Oedema = diuretics
+Stop NSAIDS

Question 13

What is the Tx for more severe CKD?

Answer 13

Stage 5 (ESRF) - RRT (DIALYSIS)
Ultimately if ESRF = renal transplant = cure

Question 14

ACE-i
Exacerbated cause of?
Used to Tx?

Answer 14

Cause of AKI
Tx in CKD

Question 15

AKI vs CKD
Definition?
Sx onset?
Anemia?
Uss?

Answer 15

AKI:
Serum creatinine high + urine output low
Shorter Sx onset
No anemia
Uss = normal

CKD:
Low eGFR
3+ Months Sx
Anemia of CKD
USS = bilateral small atrophied kidneys