Chronic Kidney Disease (CKD)

Question 1

What does chronic kidney disease (CKD) describe?

Answer 1

A chronic reduction in kidney function sustained over three months, and tends to be permanent and progressive.

Question 2

What are common causes of chronic kidney disease (CKD)?

Answer 2

• Diabetes
• Hypertension
• Medications (e.g., NSAIDs or lithium)
• Glomerulonephritis
• Polycystic kidney disease

Question 3

What are common signs and symptoms of worsening renal function in chronic kidney disease (CKD)?

Answer 3

• Fatigue
• Pallor
• Foamy urine
• Nausea
• Loss of appetite
• Pruritus
• Oedema
• Hypertension
• Peripheral neuropathy

Question 4

What does eGFR stand for, and what does it estimate?

Answer 4

Estimated glomerular filtration rate; it estimates the rate at which fluid is filtered from the blood into Bowman’s capsule.

Question 5

How is proteinuria quantified?

Answer 5

With a urine albumin:creatinine ratio (ACR).

Question 6

What is the difference between microscopic and macroscopic haematuria?

Answer 6

• Microscopic haematuria: blood identified on testing but not visible on inspection
• Macroscopic haematuria: visible blood in the urine

Question 7

What investigations are necessary to identify risk factors for chronic kidney disease (CKD)?

Answer 7

• Blood pressure (for hypertension)
• HbA1c (for diabetes)
• Lipid profile (for hypercholesterolaemia)

Question 8

What are the criteria for diagnosing chronic kidney disease (CKD)?

Answer 8

• eGFR sustained below 60 mL/min/1.73 m2
• Urine ACR sustained above 3 mg/mmol

Question 9

What does the ‘G’ score in chronic kidney disease (CKD) classification represent?

Answer 9

‘G’ stands for Glomerular Filtration Rate so is based on the eGFR.

Question 10

What does the ‘A’ score in chronic kidney disease (CKD) classification represent?

Answer 10

‘A’ stands for and is based on the albumin:creatinine ratio.

Question 11

What is accelerated progression in chronic kidney disease (CKD)?

Answer 11

A sustained decline in the eGFR within one year of either 25% or 15 mL/min/1.73 m2.

Question 12

What are common complications of chronic kidney disease (CKD)?

Answer 12

• Anaemia
• Renal bone disease
• Cardiovascular disease
• Peripheral neuropathy
• End-stage kidney disease
• Dialysis-related complications

Question 13

What is the Kidney Failure Risk Equation used for?

Answer 13

To estimate the 5-year risk of kidney failure, and therefore when they would require dialysis.

Question 14

When should a patient be referred to a renal specialist according to NICE guidelines?

Answer 14

• eGFR less than 30 mL/min/1.73 m2
• Urine ACR more than 70 mg/mmol
• Accelerated progression
• 5-year risk of requiring dialysis over 5%
• Uncontrolled hypertension despite four or more antihypertensives

Question 15

What is the blood pressure target for chronic kidney disease (CKD) patients under 80 with an ACR above 70 mg/mmol?

Answer 15

Less than 130/80.

Question 16

What medications help slow the progression of chronic kidney disease (CKD)?

Answer 16

• ACE inhibitors (or angiotensin II receptor blockers)
• SGLT-2 inhibitors (specifically dapagliflozin)

Question 17

What lifestyle changes can reduce the risk of complications in chronic kidney disease (CKD)?

Answer 17

• Exercise
• Maintain a healthy weight
• Avoid smoking

Question 18

What are treatments for anaemia in chronic kidney disease (CKD)?

Answer 18

• Iron deficiency treatment, i.e. intravenous iron
• Erythropoiesis-stimulating agents i.e. recombinant human erythropoetin
• Blood transfusions (with caution, because they can sensitise the immune system i.e. allosensitization, increasing the risk of future transplant rejection.)

Question 19

What is renal bone disease also known as?

Answer 19

Chronic kidney disease-mineral and bone disorder (CKD-MBD).

Question 20

What are key features of renal bone disease?

Answer 20

• High serum phosphate
• Low vitamin D activity
• Low serum calcium

Question 21

What management strategies are used for renal bone disease?

Answer 21

• Low phosphate diet
• Phosphate binders
• Active forms of vitamin D
• Ensuring adequate calcium intake

Question 22

What is a characteristic finding of a spinal x-ray in renal bone disease?

Answer 22

Rugger jersey spine, in which there is sclerosis of both ends of each vertebral body and osteomalacia in the center.

Question 23

What are the management options for end-stage renal disease?

Answer 23

• Special dietary advice
• Dialysis
• Renal transplant

Question 24

Under what conditions are ACE inhibitors offered to chronic kidney disease (CKD) patients?

Answer 24

• Diabetes plus a urine ACR above 3 mg/mmol
• Hypertension plus a urine ACR above 30 mg/mmol
• All patients with a urine ACR above 70 mg/mmol

Question 25

Why is close monitoring of serum potassium required in chronic kidney disease (CKD) patients on ACE inhibitors?

Answer 25

Both CKD and ACE inhibitors can cause hyperkalaemia.

Question 26

Which SGLT-2 inhibitor is licensed for chronic kidney disease (CKD)?

Answer 26

Dapagliflozin.

Question 27

Which chronic kidney disease (CKD) patients should be *considered* for dapagliflozin treatment?

Answer 27

* Diabetes plus a urine ACR of 3 to 30 mg/mmol * Non-diabetics with an ACR of 22.6 mg/mmol or above

Question 28

What type of anaemia does chronic kidney disease (CKD) typically cause?

Answer 28

Normocytic normochromic anaemia.

Question 29

What is the role of erythropoietin in healthy kidneys?

Answer 29

Stimulates the production of red blood cells.

Question 30

What is the treatment for iron deficiency in chronic kidney disease (CKD) patients?

Answer 30

Intravenous iron is usually given, especially in dialysis patients.

Question 31

Which chronic kidney disease (CKD) patients should be *offered* dapagliflozin treatment?

Answer 31

Diabetes plus a urine ACR above 30 mg/mmol

Question 32

What four objectives does treating the underlying cause of chronic kidney disease (CKD) entail?

Answer 32

* Optimising diabetic control * Optimising hypertension control * Reducing or avoiding nephrotoxic drugs, where appropriate * Treating glomerulonephritis, where this is the cause

Question 33

What is renal ultrasound used for?

Answer 33

Identifying obstructions e.g., kidney stones or tumours and polycystic kidney disease.

Question 34

What investigation is used to identify obstructions e.g., kidney stones or tumours and polycystic kidney disease?

Answer 34

Renal ultrasound

Question 35

Metabolic acidosis is a complication of chronic kidney disease (CKD) because of kidney's incapacity to excrete acid, leads to acid buildup in blood. What can be used to treat this?

Answer 35

Oral sodium bicarbonate