CKD

Question 1

Assesmment of Renal Function: Calculation tools

Answer 1

CrCl
eGFR
CKD-EPI
Glomerular Filtration Rate

Question 2

Assessing Kidney Damage

Answer 2

Haematuria - not necessary for kidney damage, infection marker
Proteinuria - kidney damage marker
Albuminuria
Significance determined by - Protein-creatinine ratio or ACR

Question 3

Causes

Answer 3

Diabetes
HTN
Drug induced - NSAID
Repeated AKI can cause CKD

Question 4

Managemen: Slowing the progression

Answer 4

Use SGLT2 inhibitors
Add ACE / ARB

Question 5

Complications

Answer 5

Anaemia
Mineral and bone disorder
CVD

Question 6

Renal Anaemia

Cause, what to give, AE, alternative, additional supplement

Answer 6

Occurs due to Erythropoeitin (EPO) deficiency
Give Erythropoiesis-Stimulating agents (ESAs) - high dose then maintenance
Blood transfusions - if a patient is resistant to ESAs
AE - increase risk of stroke and VTE, HTN, seizures, allergic reactions
Roxadustat - oral alternative to ESA
Iron supplements

Question 7

Renal Bone Disease: CKD-MBD

What happens to levels, treatments of each

Answer 7

Vit. D - low levels
Calcium - low levels due to low Vit. D
Phosphate - increases, linked to high parathyroid hormones
Treatment of Hyperphosphataemia - phosphate binders e.g. calcium acetate
Treatment of Hyperparathyroidism Vit D. - supplements
Treatment of Hyperparathyroidism Calcimimetics - Cinacalcet, Etelcalcitide
Treatment of Hyperparathyroidism - Parathyroidectomy

Question 8

Phosphate Binders

Answer 8

Calcium acetate
S/E - GI
Interactions - reduced absorption of Levo, Doxy and Cipro
Counselling - take with meals, check adherence, some are chewed some are swallowed whole

Question 9

Vit D. supplements

Answer 9

Alfacalcidol and Calcitriol
Given to correct low calcium and high PTH
S/E - increase calcium and phosphate (monitor)

Question 10

Calcimimetics

Answer 10

Cinacalcinet
Etelcalcetide IV