CKD

Question 1

What are the stages of CKD? with GFR value and diagnosis

Answer 1

Stage 1= GFR>90— normal
Stage 2= GFR 60-89 —- Mild CKD
Stage 3A= GFR 45-59 —- Mild to moderate CKD
stage 3B= GFR 30-44—- Moderate to severe CKD
Stage 4= GFR 15-29—- Severe CKD
Stage 5= GFR <15 or on dialysis—- Kidney failure

Question 2

According to stage of CKD
Clinical presentation: asymptomatic in which stages!?

Answer 2

Stage 1
Stage 2
Stage 3A

Question 3

Signs of Stage 3B

Answer 3

Anaemia in some patients
non progressive or progress very slowly

Question 4

When 1st symptoms appear on stage 4?

Answer 4

often at GFR <20

Question 5

Electrolytes problem in which stage?

Answer 5

Stage 4

Question 6

Significant signs and symptoms at which stage?

Answer 6

Stage 5

Question 7

Dialysis require in which stage?
at which level?

Answer 7

Stage 5
GFR <10

Question 8

Upto what level of GFR a patient with CKD can be asymptomatic?

Answer 8

GFR Upto 45

Question 9

What is CKD
What metabolic abnormalities appear in first
What is ESRD?

Answer 9

Irreversible deterioration of renal function usually develops over a years

biochemical abnormality

when death is likely without the RRT then it is called ESRD

Question 10

What are the common causes of CKD?

Answer 10

DM:20-45%
interstitial disease: reflux nephropathy, drug induced
Glomerular disease: IgA nephropathy
Hypertension
Systemic inflammatory disease: SLE, Vasculits
Reno vascular disease: mostly atheromatous
Congenital and inherited: PCKD, Alport syndrome
Unknown: 5-10%

Question 11

Sign and symptoms of CKD

Answer 11

Asymptomatic (incidental findings)
early symptom: Nocturia (non-specific)
tiredness
breathlessness
pruritis
anorexia
weight loss
nausea
vomitting
hiccups

Question 12

Signs of CKD

Answer 12

Head: yellow complexion, pallor
Neck: raised JVP
Chest: dialysis catheter, pericardial friction rub
Abdomen: transplanted kidney scar, dialysis, tecknocoff catheter for peritoneal dialysis
Limb: pulsus paradoxus, AV fistula, brown line pigmentation
Skin: Excoriation of skin, bruising easily, pitting oedema
Peripheral neuropthy
Absent reflexs, reduced sensation, paraesthesia, restless legs

Question 13

Whar are the initial test of CKD?

Answer 13

Creatinine, eGFR
Urinanalysis
Electrolytes
Calcium, phosphate, 1,25,vit D, PTH
Albumin
FBC (Fe, Ferritin, folate, vit B12)
Lipid glucose, HBa1C
Renal US,
Hepatitis, HIV serology
Other:

Question 14

What is kassmaul breathing?

Answer 14

Deep breathing due to metabolic acidosis
Sign of advanced renal disease

Question 15

Critaria for referral of CKD patient to a nephrologist

Answer 15

1. eGFR <30ml/min/1.73m2
2. Rapid deterioration of renal function >25% from previous or >15 ml/min/1.73m2/ year
3. significant proteinuria (PCR >100 or ACR >70)
4. ACR >30 with non visible haeamturia
5. Hypertension that is poorly controlled despite at least 4 anti hypertensive medications
6. suspicion of renal involvement in multi system disease.

Question 16

at what duration interval renal function should be checked in stage 3 CKD?

Answer 16

6 months

Question 17

target BP or Albuminuria for CKD patient

Answer 17

140/90 mmHg
ACR <3

Question 18

Target BP for DM Patient with CKD

Answer 18

130/80 mmHg

Question 19

which anti hypertensive reduce proteinuria in CKD?

Answer 19

ACEi and ARBs

Question 20

At what condition, ACEi and ARBs should be given in CKD patient?

Answer 20

Diabetic nephropathy
DM with proteinuria irrespective of whether or not htn is present

Question 21

After initiating ACEi and ARBs, when should we check renal function and why??

Answer 21

7-10 days
due to immediate reduction of GFR after giving the medicine

Question 22

For how long, ACEi and ARBs should be continued?

Answer 22

until GFR reduction not greater than 25%

Question 23

ACEi and ARBs exacerbate____
when should we advise to stop?

Answer 23

pre- renal failure due to part in auto regulation
fever, vomiting or diarrhoea

Question 24

what electrolytes imbalance occurs after taking ACEi and ARBs?
at what level should be reduced or stopped??

Answer 24

Serum potassium
>5.5 mmol/L

Question 25

At which stage of CKD, excessive consumption of Protein should be stopped?
complications of protein restriction?

Answer 25

stage 4 and 5
malnutrition

Question 26

How much potassium intake should be allowed in CKD?

Answer 26

reduce daily intake to <70 mmol/l

Question 27

How to reduce potassium in CKD?

Answer 27

dietary restrictions
calcium resonium
sodium zirconaium cryosillicate
patiromer
diuretic therapy
sodium bicarbonate
stop the drugs that increase potassium such as potassium sparing diuretics and ACEi or ARBs

Question 28

What are the medication that should be stopped during sick day rule??

Answer 28

ACE inhibitors
ARBs
NSAIDs
Diuretics: furosemide, bendroflumethiazide, indapamide, spironolactone
Metformin

Question 29

What is the NaHCO3 level target in CKD?
Sodium bicarbonate dose?

Answer 29

above 22 mmol/l
1g 3 times daily

Question 30

What type of anaemia is common in CKD?
treatment?

Answer 30

Iron deficiency anaemia
Rx of IDA

Question 31

If Iron deficiency anaemia or other cause of anaemia excluded what should be given as treatment for anaemia?

Answer 31

Recombinant human erythropoietin

Question 32

Target hb in CKD?

Answer 32

10.0 to 12.0 g/dl

Question 33

erythropoietin less effective in which condition?

Answer 33

IDA
Active inflammation
malignancy like myeloma

Question 34

Causes of anaemia in CKD?

Answer 34

deficiency of erythropoietin
toxic effects of uraemia or marrow precursor cells
reduced intake, absorption and utilisation of dietary iron
reduced red cell survival
blood loss due to capillary fragility and poor platelet function

Question 35

What are the cardiac problems in CKD?

Answer 35

HTN
Hyperlipidemia
diabetes
arrythmia
sudden cardiac death

Question 36

At what level of eGFR, RRT should start?

Answer 36

10 ml/min/1.73m2