Chronic Kidney Disease

Question 1

What is the criteria to diagnose CKD

Answer 1

Abnormality in kidney function for >3 months
- Albuminuria
- urine sediment abnormalities
- histology abnormalities
- structural abnormalities in USKUB
- GFR <60ml/min

Question 2

What are some systemic causes of CKD

Answer 2

In glomerulus
- Diabetes
- Systemic infection
- Drugs
In tubulointestinal
- Drugs
- Toxins
In vascular
- hypertension
- atherosclerosis
In cystic and congenital
- polycystic kidney disease

Question 3

What are some primary causes of CKD

Answer 3

• Glomerulonephritis
• UTI/stones or obstruction
• ANCA
• Renal dysplasia

Question 4

What are some signs of prolonged kidney failure

Answer 4

1) Fatigue
2) Anorexia
3) Vomiting
4) Pruritus

Question 5

What are some appropriate labs to do for CKD

Answer 5

• Renal panel with UECr
• FBC with white cell differential
• Urinalysis
• UPCR or UACR

Question 6

What are the 4 pillars of pharmacological management in CKD and explain how they may help

Answer 6

1) Metformin
- to manage DM. Aim HbA1c <6.5
2) SGLT2
- Decrease intraglomerular hypertension by constricting afferent arterioles
3) ACEi/ARB
- Decrease intraglomerular hypertension through efferent arterioles vasodilation (may have slight increase of creat by 10-30%)
4) Finerenone
- For type 2 diabetes who have measured or estimated albuminuria >30mg/day despite ACE inhibitor
OR 4) Mineralocorticoid antagonist
- To cause less hyperkalemia

Question 7

What are some medications to avoid if patient develops AoCKD

Answer 7

Sulfonyurea
Ace-inhibitors
Diuretics
Metformin
ARBs
NSAIDs
SGLT2 inhibitors

Question 8

What are some common complications of CKD (5)

Answer 8

1. Anemia
2. Mineral bone disease
3. Hyperkalemia
4. Acidosis
5. Fluid overload

Question 9

What is the primary therapeutic option for anemia of CKD

Answer 9

Iron and erythropoietin stimulating agents

Question 10

What is the usual aim for Hb in patients with CKD

Answer 10

10-11.5

Question 11

What are some interventions to consider when there is hyperkalemia

Answer 11

1. Stop or reduce ARBs and ACEi
2. Switch from non-selective to selective beta 1 blockers
3. Initiate thiazide or loop diuretic if overloaded
4. Consider sodium bicarbonate or GI cation exchangers (sodium zirconium cyclosilicate)

Question 12

When should bicarbonate be started in acidosis

Answer 12

When HCO3 <20. Aim HCO3 22-26

Question 13

How much sodium should CKD patients take

Answer 13

<2g per day

Question 14

What are the minimal 3 tests needed to confirm CKD

Answer 14

1. UFEME
2. Creatinine
3. US kidney

Question 15

List the grades of CKD

Answer 15

G1: >90ml/min/1.73m2
G2: 60-89
G3a: 45-59
G3b: 30-44
G4: 15-29
G5: <15

Question 16

What is the blood pressure target for patients with CKD

Answer 16

if no albuminuria: <140/80
If got albuminuria: <130/80