CKD + AKI

Question 1

What is the definition of CKD?

Answer 1

Abnormality of kidney structure or function, present for >3 months, with implications for health

Question 2

What is the definition of AKI?

Answer 2

Sudden deterioration of function in absence of prior abnormality

Question 3

Causes of CKD

Answer 3

Diabetic nephropathy

Glomerulonephritis

HTN

Systemic disease (SLE, vasculitis, myeloma)

Renal artery stenosis

Polycystic kidney disease

Pyelonephritis

Urinary tract obstruction (inc prostatic disease)

HF

NSAIDs

Question 4

How does CKD present?

Answer 4

HTN

Incidental findings on bloods

Symptoms usually late stage

Question 5

Indications for screening pts at risk of developing CKD

Answer 5

Diabetes

HTN

CV disease

Nephrotoxic drugs (NSAIDs, lithium)

Structural renal disease

Question 6

What causes a high serum urea?

Answer 6

Catabolic state

High protein intake

GI bleed

Dehydration

CV failure

Reduced renal function

Question 7

What causes a low serum urea?

Answer 7

Liver failure

Question 8

What causes a high serum creatinine?

Answer 8

Reduced renal function

Large muscle mass (young, male, muscular)

Question 9

What causes a low serum creatinine?

Answer 9

Low muscle mass (elderly, wasting, females)

Question 10

How do you calculate eGFR?

Answer 10

Calculated from blood results + demographic data (age, gender, race)

Question 11

How is proteinuria measured + why is it important?

Answer 11

Measured in urine sample as protein: creatinine ratio (PCR) or albumin: creatinine ratio (ACR)

Guides management

Question 12

How would you investigate the cause of CKD?

Answer 12

Haematology/ biochem

Urine dip + MC+S

Immunology screen

Renal USS +- biopsy

Question 13

What is the normal function of the kidneys?

Answer 13

Excrete substances

Homeostasis - fluid balance, BP, acid-base

Endocrine - erythropoietin, bone metabolism

Question 14

Metabolic complications of CKD

Answer 14

Anaemia

Bone mineral disorder (low Ca, high PO4, high PTH

Metabolic acidosis (low bicarb)

Hyperkalaemia

Question 15

Clinical features of CKD

Answer 15

Renal: fluid retention, polyuria, polydipsia

CV: HTN, pulmonary oedema, vascular disease, dyslipidaemia

GI: anorexia, N+V, peptic ulcers

Neuro: neuropathy

Derm: pruritis, pigmentation

Endocrine: amenorrhoea, reduced fertility

MSK: bone pain, fractures

Question 16

When to refer pt to renal care

Answer 16

eGFR <30

Progression

Uncertain cause

Possible hereditary disease

Significant proteinuria

Haematuria + proteinuria

Question 17

Management of CKD

Answer 17

BP control

CVS risk reduction - statins

Diet

Vit D, folic acid, iron, phosphate control

Bicarbonate supplements

Dialysis

Question 18

What are the RF for progression?

Answer 18

Lower eGFR

BP control

Proteinuria

Smoking

Hyperglycaemia

Obesity

Nephrotoxic drugs

Question 19

What diet is recommended with CKD?

Answer 19

Restrict salt

Restrict calories

Restrict phosphate + potassium

Question 20

What is the target BP for CKD?

Answer 20

Less than 140/90

Question 21

How to manage HTN in CKD?

Answer 21

ACEi or ARBs except in renal artery stenosis

Question 22

Which drugs can cause hyperkalaemia in CKD?

Answer 22

ACEi, ARBs, amiloride, spironolactone, potassium

Question 23

When is dialysis needed?

Answer 23

When eGFR is <10

Question 24

What are the options for ESRD management?

Answer 24

Haemodialysis

Peritoneal dialysis

Kidney transplant

Conservative care

Question 25

What is CAPD vs APD?

Answer 25

CAPD: continous ambulatory peritoneal dialysis. 4x 2-3L exchanges per day APD: automated PD - while asleep at night

Question 26

What are the symptoms of AKI?

Answer 26

Anorexia Headache N+V Arrhythmias Change in BP Pain in flanks

Question 27

What are the U+E findings for CKD?

Answer 27

Hyperkalaemia Hypercalcaemia Hyponatraemia

Question 28

Pre renal causes of AKI

Answer 28

Ischaemia, D+V, sepsis, renal artery stenosis

Question 29

Intrinsic causes of AKI

Answer 29

Damage to glomeruli, interstitialRhabdomyolysis

Question 30

Post renal causes of AKI

Answer 30

Kidney stones, BPH, external compression of ureter

Question 31

S+S of AKI

Answer 31

Confusion, N+V, oliguria, haematuria

Question 32

Investigations + results for AKI

Answer 32

FBCs (anaemia indicates acute on chronic)U+E (K+, creatinine + urea) ECGUrinalysis, ABGUSSCXR

Question 33

Management of AKI

Answer 33

Treat sepsis, stop nephrotoxins (NSAIDs, gentamicin, ACEi, ARBs, diuretics, metformin, lithium, digoxin, heparin), optimise BP Fluids IV calcium gluconate if hyperkalaemic Insulin + dextrose transfusion Treat oedema with furosemide, GTN, CPAPTreat acidosis = IV bicarbonate

Question 34

Criteria used to define AKI

Answer 34

KDIGO/ RIFLE: 1) \>50% rise in serum creatinine within last 7 days 2) Increase in creatinine by \>26.5 within 48hrs 3) urine output \<0.5ml/kg/hr for more than 6hrs

Question 35

Severity of AKI

Answer 35

1: 1.5-2x baseline creatinine 2: 2-3x baseline 3: \>3x baseline