Chronic Kidney Disease

Question 1

How can chronic kidney disease be defined?

Answer 1

• GFR < 60 for more than 3 months OR
• Evidence of kidney damage +/- GFR derangement for > 3 months
  
  • Microalbuminuria
  • Proteinuria
  • Glomerular haematuria
  • Pathological/anatomical abnormalities

Question 2

How are the stages of CKD stratified? When do symptoms normally begin to occur?

Answer 2

• Based on GFR with further stratification for urinary protein
• CKD5 (GFR 0-15)

Question 3

What are the risk factors for development of chronic kidney disease? For progression?

Answer 3

• Development
  
  • Older age (>55)
  • Hypertension
  • Diabetes
  • Smoking
  • Obesity
  • 1st degree family history
• Progression
  
  • High levels of proteinuria
  • High blood pressure

Question 4

What is the most important modifiable risk factor for CKD progression?

Answer 4

Hypertension

Question 5

What are the principles of managment of CKD?

Answer 5

• Determine underlying cause
• Reduce further progression and decrease CV risk
  
  • BP, lipids, glucose control, cease smoking, salt restriction
• Detection and management of metabolic complications
  
  • Anaemia, Ca/PO4/PTH, acidosis (give bicarbonate)
• Medication management
  
  • Avoid nephrotoxic agents
• Renal replacement therapy (CKD4-5 only)
  
  • Haemodialysis
  • Peritoneal dialysis
• Renal transplant