Chronic Kidney Disease (CKD)

Question 1

Chronic kidney disease can also describe abnormal kidney structure as well as abnormal function. TRUE/FALSE?

Answer 1

TRUE

Question 2

CKD often co-exists with what 2 common diseases?

Answer 2

Cardiovascular disease

Diabetes

Question 3

Moderate to severe CKD increases the risk of what complications?

Answer 3

acute kidney injury
falls
frailty
mortality

Question 4

What makes kidney disease “chronic”?

Answer 4

Abnormal U and Es after 90 days

• creatinine still raised
• eGFR still low

Question 5

eGFR is based upon what 4 factors?

Answer 5

serum creatinine
age
sex
race

Question 6

How is renal failure graded, and what grade indicates end stage renal failure?

Answer 6

G1-G5

G5 = eGFR <15= end stage renal failure

Question 7

What is used to investigate proteinuria?

Answer 7

Albumin:Creatinine Ratio (ACR)

Question 8

Microalbuminuria is an indication of generalised vascular endothelial damage. TRUE/FALSE?

Answer 8

TRUE

Question 9

What type of protein is albumin?

Answer 9

Glomerular

Question 10

An ACR of <3 is abnormal. TRUE/FALSE?

Answer 10

FALSE

<3 is normal

Question 11

An ACR of >30 indicates what category of ACR?

Answer 11

A3 => at risk of progressive loss of kidney function

Question 12

People who experience an acute kidney injury are at increased risk of developing CKD. TRUE/FALSE?

Answer 12

TRUE

Question 13

How should patients with AKI be monitored for development of CKD?

Answer 13

Monitor for at least 2–3years after AKI

** even if serum creatinine has returned to baseline**

Question 14

If eGFR is between 45 and 59 but there are no other signs of CKD, what can be measured to double check for CKD?

Answer 14

Cystatin C

Question 15

Cystatin C must be under what level for there to be no evidence of CKD?

Answer 15

<60

Question 16

What is an ACCELERATED progression of CKD?

Answer 16

Decrease in GFR of 25% or more
Change in GFR category
- within 1 year

OR

• decrease in GFR of 15 ml/min/1.73m2 per year

Question 17

What are the risk factors for CKD progression?

Answer 17

• CVD/ Hypertension
• Proteinuria
• AKI
• Diabetes
• Smoking
• African, African-Caribbean or Asian family origin
• Chronic use of NSAIDs
• Untreated urinary obstruction

Question 18

When should patients with CKD be referred for specialist assessment?

Answer 18

• GFR <30 (=> G4 or G5 +/- diabetes)
• ACR 70 mg or more
• ACR 30 mg + haematuria (ACR category A3)
• Accelerated progression of CKD
• Hypertension = Poorly controlled despite use of 4 antihypertensive drugs
• Suspected renal artery stenosis

Question 19

What is the aim for blood pressure in CKD patients who have diabetes or an ACR of 70 or more?

Answer 19

130/80mmHg

Question 20

What factors must be considered when increasing the dose of an ACE Inhibitor or Angiotensin Receptor Blocker?

Answer 20

Difference in GFR and serum creatinine from the baseline

Question 21

Patients with CKD do not need to have had a primary cardiovascular event to be put on Atorvastatin 20mg. TRUE/FALSE?

Answer 21

TRUE

Question 22

What are the causes of CKD?

Answer 22

• Glomerulonephritides
• Vascular Disease(macro and micro)
• Small Vessel Vasculitis
• Post-Renal Obstruction
• Tubulointerstitial Disease

Question 23

What are the clinical signs of CKD?

Answer 23

• Anaemia
• Weight loss
• Uraemia
• Lemon yellow tinge (not jaundice)
• Uraemic frost (sweating out uraemic toxins
• Encephalopathic flap
• Twitching
• Confusion
• Pericardial rub or effusion
• Kussmaul breathing

Question 24

A pericardial rub or effusion is a direct indication for what?

Answer 24

Dialysis to get rid of uraemic toxins and prevent cardiac tamponade

Question 25

What are the 3 classifications of symptoms in CKD?

Answer 25

Uraemic (N+V, twitching, wt loss) Anaemic (fatugue, muscle weakness) Pain

Question 26

What complications of CKD can occur locally?

Answer 26

pain/ haemorrhage/ infection

Question 27

What are the urinary complications of CKD?

Answer 27

haematuria/ proteinuria | Impaired salt and water handling

Question 28

What is the eventual complication of CKD?

Answer 28

End stage renal failure

Question 29

What are the extra-renal complications of CKD?

Answer 29

- Cardiovascular disease (CVD) - Mineral and Bone Disease (CKD-MBD) - Anaemia

Question 30

What modalities are considered Renal Replacement Therapies (RRT)?

Answer 30

Haemodialysis (HD) Peritoneal Dialysis (PD) Transplantation

Question 31

Patients have the choice of Renal Replacement Therapy or Conservative Management to maximise what?

Answer 31

Their "hospital free" days

Question 32

A 25-34 year old patient on dialysis has the same cardiovascular risk as a non-dialysis patient who is around 85 years of age. TRUE/FALSE?

Answer 32

TRUE

Question 33

What compounds are involved in CKD Mineral and Bone Disorder?

Answer 33

``` Calcium Phosphate PTH Vit D FGF-23 ```

Question 34

What are the main consequences of CKD Mineral and Bone Disorder?

Answer 34

Secondary/ tertiary Hyperparathyroidism Vascular calcification Bone pain Fractures CV events

Question 35

What dietary advice may be useful in CKD Mineral and Bone Disorder?

Answer 35

- Phosphate restriction (if high) - Salt reduction - Potassium restriction - Fluid restriction

Question 36

What medications can be used in CKD Mineral and Bone Disorder?

Answer 36

- Alfacalcidol (‘Active’ vitamin D) - Phosphate binders - Calcimimetic (Cinacalcet)

Question 37

What patient groups are more at risk of anaemia in CKD?

Answer 37

- those with eGFR <45 | - diabetics

Question 38

What are the target Hb levels for CKD patients and why?

Answer 38

Hb 100 – 120 (slight anaemia) | => makes blood less sludgy and easier to push around body

Question 39

What other causes of anaemia must be considered in CKD?

Answer 39

Exclude B12 and folate deficiency Check ferritin and Iron

Question 40

What forumlation of iron does not work effectively to replete iron stores in renal anaemia?

Answer 40

ORAL