CKD

Question 1

What is chronic kidney diseas

Answer 1

Chronic kidney disease (CKD) is defined as an abnormality of kidney structure or function that persists for > 3 months.

Question 2

what is the cause of CKD

Answer 2

diabetes mellitus, hypertension, and glomerulonephritis

Question 3

what are patients with CKD at risk of developing?

Answer 3

atherosclerotic cardiovascular disease (ASCVD)

Question 4

what is the treatment goal for CKD

Answer 4

slow CKD progression and prevent and manage complications

Question 5

how is asvd managed in CKD

Answer 5

using statin therapy and adequate treatment of diabetes mellitus

Question 6

what are the symptoms of CKD

Answer 6

fluid overload (e.g., peripheral edema) and/or uremia (e.g., fatigue, pruritus)

Question 7

WHAT ARE RISK FACTORS OF CKD

Answer 7

Diabetes
Hypertension
Obesity
Advanced age (> 60 years of age)
Substance use (smoking, alcohol, recreational drugs)
Acute kidney injury

Question 8

what is the egfr for CKD

Answer 8

eGFR < 60 mL/min/1.73 m2

Question 9

what would you find in a urine dipstick for CKD

Answer 9

proteinuria

Question 10

what happens to the egfr with CKD

Answer 10

egfr decreases

Question 11

what happens to the creatinine in CKD

Answer 11

it increases

Question 12

what is the nutritional management for CKD

Answer 12

Sodium restriction
Potassium intake adjustment
Phosphorus intake adjustment

Question 13

what is the first line therapy for BP control

Answer 13

ACEI OR ARB

Question 14

what monitoring should be done in CKD

Answer 14

serum potassium, calcium, and phosphate levels is essential.

Question 15

what is egfr

Answer 15

A blood test which provides us with an estimate as to how well the kidneys are filtering (ml/min)

As eGFR drops – so does the ability of the kidney to function

Question 16

what is albuminuria

Answer 16

Albuminuria is a marker of kidney damage

↑ albuminuria =↑ risk of CKD progression & cardiovascular events

Question 17

what are the measurements of proteinuria

Answer 17

uPCR
uACR

Question 18

what are the management aims of CKD

Answer 18

Treat underlying condition

Reduce risk of CKD progression

Reduce cardiovascular risk

Question 19

What is the leading cause of end-stage renal disease

Answer 19

Diabetes is the leading cause

Question 20

why are acei or arbs used?

Answer 20

RAASi are renoprotective

Question 21

why slgt-2 inhibitors (flozins)

Answer 21

Inhibit sodium-glucose cotransporter 2 (SGLT-2) in the PCT of the kidney

↓glucose reabsorption leading to↑glycosuria = reduced blood glucose levels

Question 22

how is cvd risk reduced in ckd patients

Answer 22

Offer statin to all patients with CKD regardless of cholesterol levels

NICE Guidance – atorvastatin 20mg OD

Question 23

how is gastrointestinal symptoms treated

Answer 23

treat with conventional antiemetics and laxatives

Question 24

how is muscle cramp symptoms treated

Answer 24

treat with oral quinine preparations

Question 25

how is fluid retention treated

Answer 25

Restricting fluid intake to 1 – 3 litres per day Reducing dietary sodium intake and avoid sodium-containing medicines where possible Loop diuretics. Higher doses are needed in patients with advanced CKD (eGFR < 30ml/min) due to diminished tubular secretion

Question 26

how is metabolic acidosis treated

Answer 26

Managed with oral sodium bicarbonate 1 – 6g daily

Question 27

what are complications of ckd

Answer 27

Cardiovascular disease Anaemia of chronic disease (renal anaemia) Mineral and bone disorder

Question 28

why does ckd cause anaemia

Answer 28

IRON DEFICIENCY REDUCTION IN ERYTHROPOIESIS

Question 29

how is renal anaemia treated

Answer 29

Synthetic version of erythropoietin – stimulates bone marrow to make red blood cells Must have sufficient iron stores therefore IV iron may be given Given IV (HD patients) or SC (CKD or PD) Epoetin Alfa (Eprex) – starting 2000-3000 units 2-3 a week Darbopoetin Alfa (Aranesp) – starting 20micrograms weekly (can be fortnightly) Oral agent- Roxadustat (HIF-PHI) Titrate to achieve Hb 100-120g/L Monitor blood pressure! If too high may need to pause ESA treatment

Question 30

what is mineral and bone disorder

Answer 30

Disorder in CKD caused by mineral imbalance = skeletal and vascular problems

Question 31

how is mineral and bone disorder treatment

Answer 31

Bind to dietary phosphate preventing it being absorbed MUST be taken with meals (immediately before/during/straight after)

Question 32

what are types of phosphate binders are there

Answer 32

calcium and non calcium based

Question 33

when is dialysis started

Answer 33

Dialysis usually started in CKD stage 5 with eGFR < 15 and symptoms of uraemia