Renal Disease in Family Practice

Question 1

Most common causes of CKD seen in family practice

Answer 1

Hypertensive nephrosclerosis/glomerulosclerosis

Diabetic nephropathy (only ~10% of diabetics)

Question 2

5 secondary causes to look for on history

Answer 2

Infections
Auto-immune
Malignancy
Drugs
Metabolic (diabetes, obesity)

Question 3

What is the purpose of looking at urine protein?

Answer 3

To differentiate between glomerulosclerosis and real diabetic nephropathy

Question 4

Urine protein interpretation: Is the renal endothelium healthy?

Answer 4

<1.9 mg/mmol: Yes, it is healthy
>1.9 mg/mmol: It may not be healthy

Question 5

Normal PCR value

Answer 5

<1.5 g/g (0.15 g/day)

Question 6

<1g/g

Answer 6

Tubular: Not all protein is reclaimed in the PCT

• glomerulosclerosis
• hypertensive nephropathy
• ischemic nephropathy

Question 7

1-3 g/g

Answer 7

Non-diagnostic

Question 8

> 3g/g

Answer 8

Always glomerular: glomerulonephritis of some kind

Question 9

Glomerulosclerosis is a CKD associated with … proteinuria and … decline in renal function.

Answer 9

Glomerulosclerosis is a CKD associated with <1g proteinuria and SLOW decline in renal function.

Question 10

Glomerulosclerosis exacerbating agents

Answer 10

NSAID use
Volume contraction
IV radioconstrast
Covid
Hypotension

Question 11

Glomerulosclerosis patients tend to be volume sensitive. Explain.

Answer 11

Creatinine will fluctuate if they are volume contracted (.e. diarrhea, influenza) and they cannot upkeep fluid.

Question 12

A patient with a 5-year risk of <10% (glomerulosclerosis) do not require a nephrologist consult unless… (2)

Answer 12

Pregnant
Hematuria

Question 13

Management of low risk glomerulosclerosis

Question 14

BP management with RASi

Question 15

What homeostatic disturbance is associated with the use of RASi?

Answer 15

Hyperkalemia

Question 16

What is the purpose of SGLT2-inhibitors?

Answer 16

Inhibit sodium-glucose reabsorption in the PCT. They have cardiovascular AND kidney protective effects.

Question 17

Main side-effect/risk of SGLT2i?

Answer 17

Genitourinary infections

Question 18

RAMQ

Answer 18

Any patient with CKD for whom RASi did not provide much benefit, SGLT2i are now covered by RAMQ.

Question 19

Existing CKD treatments as of 2025

Answer 19

1. Lifestyle measures, glucose control, BP control, lipid management
2. RASi
3. SGLT2i
4. Finerenone

Question 20

Consequences of stage 5 CKD (6)

Answer 20

Anemia
Hyperkalemia
Acidosis
Bone disease
Volume overload
Hypertension

Question 21

Consider a nephrology referral for patients with…

Answer 21

• CKD, with kidney failure risk score >10% in 5 years
• > 1g/day proteinuria (>100 mg/mmol albumin with any Cr)
• Proteinuria with hematuria
• Pregnancy