Renal

Question 1

What is chronic kidney failure?

Answer 1

• chronic reduction in function sustained over 3 months
• permanent and progressive

Question 2

What is the presentation of chronic kidney disease?

Answer 2

• fatigue
• oedema
• pruritus
• loss of appetite
• nausea
• hypertension

Question 3

What are risk factors for chronic kidney failure?

Answer 3

• older age
• diabetes
• hypertension
• smoking
• nephrotoxic medication

Question 4

What are common causes of CKD?

Answer 4

• diabetes (nephropathy)
• hypertension
• age
• glomerulonephritis
• PKD
• meds: NSAIDs, PPIs, lithium

Question 5

What is the pathophysiology behind chronic kidney disease?

Answer 5

• damaged nephrons > reduced GFR
• inc burden on remaining nephrons
• compensatory RAAS to inc GFR causes inc transglomerular pressure and damages basement membrane selectiveness
• leads to proteinuria and haematuria
• mesangial scarring

Question 6

What investigations are done in chronic kidney disease?

Answer 6

• urine dip for haematuria
• eGFR with U&E: 2 tests 3 months apart
• albumin:creatinine (ACR)
  >3mg/mmol is significant
• BP, HbA1c and lipids

Question 7

How is CKD managed?

Answer 7

• ACEi and SGLT2
• exercise + healthy weight
• atorvastatin to prevent CVD

Question 8

How is hypertension in CKD treated?

Answer 8

• ACE inhibitors (accept a decrease in eGFR up to 25%)
• Furosemide if GFR <45
• dapagliflozin (SGLT2) if diabetic

Question 9

What is the criteria for chronic kidney disease?

Answer 9

eGFR <60mL/min/1.73m^2

Question 10

What are the 5 stages of chronic renal disease?

Answer 10

• 1 = >90
• 2 = 60-89
• 3a = 45-59 (moderate)
• 3b = 30-44
• 4 = 15-29 (severe)
• 5 = <15 (end-stage renal failure)

Question 11

What causes anaemia in CKD?

Answer 11

• CKD > lower erythropoietin
• causes normocytic normochromic anaemia
• treat iron deficiency first then erythropoietin

Question 12

What bloods are seen in renal bone disease in CKD?

Answer 12

• high phosphate
• low vit D
• low calcium

Question 13

What is the pathophysiology of renal bone disease in CKD?

Answer 13

• dec phosphate excretion > high serum phosphate
• low vit D and low calcium
• more parathyroid hormone excreted > 2º hyperparathyroidism
• stimulates osteoclasts > inc Ca absorption
• osteomalacia and osteosclerosis

Question 14

What is a key finding on spinal X-Ray of renal bone disease in CKD?

Answer 14

• rugger jersey spine
• sclerosis of vertebral body and osteomalacia in centre

Question 15

How is renal bone disease in CKD managed?

Answer 15

• low phosphate diet
• phosphate binders
• active vit D
• adequate calcium intake