CKD

Question 1

Describe APCKD
Define (1)
Symptoms (2)
Testing / screening (2)
Treating. (2)

Answer 1

Adult polycystic kidney disease is an autosomal dominant disease that occurs most frequently from new mutations.
Cysts grow with age and are USS diagnosable. They’re painful, bleeding, infection, renal stones, increased risk of brain aneurysms and heart valve abnormalities.
Genetic testing is available but expensive - only available if you want to donate a kidney.
Treated by treating hypertension, blocking ADH, drinking lots, low salt diet.

Question 2

Define CKD. (3)

Answer 2

The irreversible and progressive loss of renal function over months to years. It’s associated with higher CVS risk.

Question 3

Describe how you stage CKD. (2)

Answer 3

Comparing GFR to albuminuria - lower GFR + hyperalbuminuria = worse CKD.

Question 4

Describe the epidemiology of CKD. (3)

Answer 4

More common in elderly, ethnic minorities, social deprivation, multiple co-morbidities.

Question 5

Describe the effects on life expectancy. (1)

Answer 5

Reduces it even with transplant (-20) or dialysis (-35).

Question 6

Describe the microscopic changes in CKD. (2)

Answer 6

Fibrotic cortex, sclerotic glomeruli, arteries thickened, inflammatory infiltrate - “thyroidisation”

Question 7

Describe the pathogenesis of CKD. (10)

Answer 7

Diabetes, hypertension, Glomerulonephritis, pyelonephritis, APCKD, Alport’s, obstruction, ATN, myeloma, idiopathic.

Question 8

Describe the investigations of CKD.

Answer 8

BP, creatinine, dipstick. 
Blood tests
Autoimmune screens, ANCA screen (vasculitis), Ig screen (myeloma). 
USS - size and hydronephrosis. 
Kidney biopsy 
CT or MRI - stones or masses. 
MR angiogram - renal artery stenosis.

Question 9

Describe the management of modifiable risk factors. (6)

Answer 9

Smoking, obesity, lack of exercise, uncontrolled diabetes, hypertension, high lipid profile.

Question 10

Describe how to manage other symptoms of CKD. (4)

Answer 10

Regulate salt and water - anti-hypertensives, diuretics, fluid restriction.
Hyperkalaemia - less likely if fluid output maintained. May require drugs stopping for a while.

Question 11

Describe the causes and treatment of anaemia in CKD. (3)

Answer 11

Reduced EPO production, iron deficiency, blood loss, acidosis reducing lifespan of RBC. Treat first with iron replacement therapy then with exogenous EPO.

Question 12

Describe mineral bone disease in CKD. (3)

Answer 12

Holding onto phosphate because excretion is reduced, leading to increased PTH, leading to non-bone calcification.

Question 13

Define end stage renal failure. (1)

Answer 13

When death is likely without renal replacement therapy. eGFR < 15ml/min.

Question 14

Describe the symptoms of end stage renal failure. (6)

Answer 14

Tiredness, difficulty sleeping, difficulty concentrating, fluid overload, nausea and vomiting, cramps, pruritis, reduced fertility.

Question 15

Describe unit based haemodialysis (2), it’s advantages (2) and disadvantages (3) and it’s complications. (3)

Answer 15

4 hours, 3 times per week in a designated slot.
A: less responsibility, days off.
D: travel time, tied to dialysis times, big food restrictions.
Complications: failed venous access, HF, coagulopathy, line infections, chronically feeling unwell.

Question 16

Describe home haemodialysis (2) and it’s disadvantages (1).

Answer 16

Allows more dialysis hours so patients feel generally better.
Requires someone to be with the patient all the time.

Question 17

Describe peritoneal dialysis (2), it’s advantages (3), disadvantages (2) and complications (3).

Answer 17

Can be 4-5 bags throughout the day or an overnight infusion.
A: self-sufficient, less fluid or food restrictions, can be easier to travel with bags.
D: responsibility, frequent changes.
Complications: peritonitis (every 20 months), adhesions, failure of the peritoneum, develop hernias, or leak fluid into scrotum or diaphragm.

Question 18

Describe the advantages and disadvantages of a transplant.

Answer 18

A: better quality of life, reduced morbidity and mortality compares to dialysis.
D: peri-operative risk, malignancy, diabetes, hypertension and infection risks increased (immunosuppresion). Meds can also have side effects: GI ulceration, raised cholesterol, weight gain, osteoporosis.