CKD

Question 1

Define CKD

Answer 1

pathological abnormality of the kidney, such as haematuria and/or proteinuria, or a reduction in the GFR to <60 mL/minute/1.73 m^2 for ≥3 months’ duration

Question 2

When do people usually present / CKD?

Answer 2

End stage

Question 3

Aetiology of CKD?

Answer 3

• Most common cause = DM
Hypertension
Less common = polycystic kidney disease, Alport’s, HIV, Atherosclerosis, SLE, glomerulonephritis, amyloidosis

Question 4

RFs of CKD

Answer 4

•	DM
•	Hypertension
•	Older age >50
•	FH
•	Smoking
•	Obesity
•	Systemic AI
o	SLE, RA

Question 5

Epidemiology of CKD

Answer 5

• Common condition, often unrecognised until advanced stages
o Incidence in UK >100 in a million
• Higher incidence in Asian immigrants

Question 6

Presenting symptoms of CKS

Answer 6

GFR >30ml/min - typically asymptomatic
•	Anorexia
•	Nausea
•	Malaise
•	Pruritus (uraemia)
•	Later - hyperkalaemia
o	Diarrhoea
o	Drowsiness
o	Convulsions
o	Coma
•	Peripheral oedema
•	Sexual dysfunction
•	Symptoms of the cause
o	Arthralgia 
•	Symptoms of the complications
o	Bone pain

Question 7

Consequences of CKD?

Answer 7

Reduced homeostasis
Reduced endocrine
Cardiovascular disease
Uraemia

Question 8

What signs might you see in the hands (CKD)

Answer 8

o Leuconychia
o Brown line at the distal end the nail
o AV fistula (buzzing lump in wrist/forearm)

Question 9

What signs might you see in the urine (CKD)

Answer 9

o Foamy urine (proteinuria)

o Cola-coloured urine (haematuria)

Question 10

What systemic signs might you see (CKD)

Answer 10

o	Kussmaul's breathing (metabolic acidosis)
o	Signs of anaemia (low EPO)
o	Oedema (hypoalbuminaemia)
o	Pigmentation (uraemia)
o	Scratch marks (uraemia)

Question 11

Investigations for CKD

Answer 11

•	Previous renal function
•	Urinalysis 
Urine microscopy
24h urine collection
ABG
Bloods
US
CXR

Question 12

Name some findings indicative of CKD in urinanalysis

Answer 12

o Glomerular disease
 RBCs, red cell casts, proteinuria (often heavy)
o Tubular disease
 Minimal blood, small protein, granular/white cell casts

Question 13

What might you see on urine microscopy?

Answer 13

Cells and casts

Question 14

What results might you get from a 24h urine collection?

Answer 14

o Protein: Positive

o Creatinine clearance: Low

Question 15

What results might an ABG give you?

Answer 15

Hypoxia

Acidosis

Question 16

What blood tests might you do and what results could indicate CKD

Answer 16

U+Es
 Urea: Low
 Creatinine: Low
 eGFR: Low

Calcium, phosphate
 Calcium: Low
 Phosphate: Raised

Immunology
	ANCA, anti-GBM, SLE immunology
FBC - Normochromic, normocytic anaemia
Glucose
Myeloma screen 
	Protein electrophoresis, urine BJP (bence-jones protein)

Question 17

Why might you do an US?

Answer 17

To exclude obstruction

Small kidneys

Question 18

What CXR results would indicate CKD?

Answer 18

o Fluid overload, chest infection