Chronic Kidney Disease

Question 1

definition of chronic kidney disease

Answer 1

GFR<60ml/min for >90 days

Question 2

causes of CKD

Answer 2

diabetes
hypertension
glomerulonephritis
cystic kidney disease
renovascular disease

Question 3

what is the equation for calculating creatinine clearance

Answer 3

cockcroft and gault equation
men
GFR = ([140-age] x LBW x 1.22)/creatinine

women
GFR = ([140-age] x LBW x 1.04)/creatinine

LBW = lean body weight

Question 4

what does the MDRD equation calculate

Answer 4

eGFR

Question 5

what type of urine sample is required for creatinine clearance test

Answer 5

24 hour

Question 6

is serum creatinine a good marker of renal function

Answer 6

no

Question 7

what are the creatinine clearance/GFR values for the five stages of CKD

Answer 7

Stage 1 - 120-90
Stage 2 - 89-60
Stage 3 - 59-30
Stage 4 - 29-15
Stage 5 - 15-0

Question 8

what is required for the diagnosis of CKD

Answer 8

stage 1 and 2 - abnormal ultrasound/radiology or biopsy or hypertension or proteinuria in addition to moderately reduced GFR
stage 3 to 5 - only need low GFR

Question 9

strategies for prevention of progression of CKD

Answer 9

control of BP (renin-angiotensin system inhibition)
reduce proteinuria (RAS inhibition)
if diabetes - optimise glycaemic control (SGLT2 inhibitors)

Question 10

what two markers indicate prognosis of CKD

Answer 10

GFR
albuminuria

Question 11

is proteinuria a marker or a cause of CKD

Answer 11

both

Question 12

what happens when too much protein passes through the renal filter into the tubule

Answer 12

tubule cells are overloaded and die
macrophages try to repair the damage which leads to scarring and fibrosis

Question 13

how do ACEis help prevent progression of CKD

Answer 13

cause vasodilation of the efferent arteriole
which mean less protein passes through the filter into the tubule
so the tubular cells don’t get overloaded
so there is less fibrosis

Question 14

what drug should be avoided in those with CKD

Answer 14

NSAIDs
contrast (when GFR <30)
gentamicin
phosphate enemas

Question 15

how does drug dosing change in CKD

Answer 15

many drugs need to be given at lower doses

Question 16

what drugs need to be given in lower doses in those with CKD

Answer 16

many but especially chemotherapy and antibiotics

Question 17

where can you get info on drug dosing in CKD

Answer 17

BNF

Question 18

what percentage of elderly patients have CKD

Answer 18

> 25%

Question 19

complications of end stage kidney disease

Answer 19

hypertension which can lead to:
left ventricular hypertrophy
stroke
end organ damage - e.g. eyes and kidneys

Question 20

what are the BP treatment goals in CKD

Answer 20

130/80
or 125/75 in diabetes or proteinuria

Question 21

what effect does good hypertension control have on GFR compared to uncontrolled hypertension

Answer 21

uncontrolled - GFR will decrease much more rapidly

Question 22

treatment of hypertension

Answer 22

low salt diet
exercise
reduce alcohol
reduce smoking
drugs (ACEi, ARB, BB, CCB, alpha blockers)

Question 23

what ion is it important to monitor in CKD

Answer 23

K+

Question 24

at what GFR is hyperkalaemia common

Answer 24

<25

Question 25

when might hyperkalaemia occur in GFR>25

Answer 25

diabetes type 4 renal tubular acidosis ACEi use high K diet

Question 26

what commonly happens to K levels in stage 5 CKD patients

Answer 26

hyperkalaemia

Question 27

what are the management options for hyperkalaemia

Answer 27

reduce K+ dietary intake potassium binders - short term as expensive

Question 28

name foods high in K

Answer 28

'student diet' orange juice bananas beer wine coffee chocolate crisps nuts baked potatoes chips beans

Question 29

what is the cause of acidosis in CKD

Answer 29

animal protein in food and inability to acidify urine

Question 30

what is the cause of acidosis in CKD

Answer 30

animal protein in food and inability to acidify urine

Question 31

treatment of acidosis in CKD

Answer 31

sodium bicarbonate replacement

Question 32

what type of anaemia is normally seen in CKD patietns

Answer 32

normochromic normocytic anaemia

Question 33

causes of aneamia in CKD patients

Answer 33

decrease response of erythropoetin to hypoxic stimulus of the kidney RBCs surviving for less time iron deficiency blood loss - dialysis, blood samples hyperparathryoidism B12 and folate deficiencies

Question 34

treatment for anaemia in CKD

Answer 34

for those with Hb <10.5 and and adequate iron stores they should be on Epo

Question 35

how does CKD cause renal osteodystrophy

Answer 35

kidneys can hydroxylate vit D so Ca not absorbed as much from diet which can lead to osteomalacia/rickets also low Ca prompts PTH to increase - secondary hyperPTHism increases Ca phosphate resorption from bones causing bone disease kidneys can't get rid of excess phosphate

Question 36

foods with high phosphate

Answer 36

meat dairy scones

Question 37

treatment of rneal osteodystrophy

Answer 37

phosphate restriction vitamin D therapy monitor PTH parathroidectomy may be required

Question 38

what are the consequences of hyperphosphataemia

Answer 38

vessel calcification which leads to - non compliant vessels - systolic hypertension -> left ventricular hypertrophy - diastolic hypotension -> myocardial ischaemia calciphylaxis (ulceration) calcification of joints

Question 39

what type of vascular calcification occurs due to hyperphosphataemia

Answer 39

medial (within wall of blood vessel and encircling whole width) intimal calcification is atherosclerosis

Question 40

what is calciphylaxis

Answer 40

when calcium accumulates in small blood vessels of the fat and skin tissues which causes blood clots, painful skin ulcers and may cause serious infections that can lead to death

Question 41

what happens to risk of death when on haemodialysis`

Answer 41

increases significantly 25 yo on haemodialysis has same irks of death as a healthy 75 yo

Question 42

why are CKD patients at risk of malnutrition

Answer 42

decreased protein intake due to dietary restrictions decrease appetite low albumin possibly due to inflammation and infection

Question 43

is low protein diet beneficial in end stage kidney disease

Answer 43

no

Question 44

who should you refer to the renal clinic

Answer 44

those with a rapid increase in creatinine or hypertension stage 3 CKD with hypertension, proteinuria, haematuria or rising creatinine stage 4/5 CKD who are suitable for treatment late stage signs of kidney disease if not already been picked up (should be picked up earlier than this though)

Question 45

what type of dialysis can be done at home

Answer 45

peritoneal

Question 46

what does peritoneal dialysis involve

Answer 46

draining used dialysate solution from peritoneal cavity filling with new solution allowing the cleaning to happen repeating

Question 47

what creatinine clearance value should you start dialysis

Answer 47

9-14