CKD

Question 1

what is this?

Answer 1

chronic reduction in kidney function

Question 2

outline stages as per GFR

Answer 2

G1 = eGFR>90

G2= 60-89

G3a= 45-59

G3b= 30-44

G4= 15-29

G5= <15 aka end stage renal failure

Question 3

causes?

Answer 3

• DM
• HT
• age related decline
• polycystic kidney disease
• glomerulonephritis
• drugs ie NSAIDS

Question 4

presentation?

Answer 4

usually asymptomatic but can also present w

• itching
• oedema
• nausea
• loss of appetite
• peripheral neuropathy

Question 5

Ix?

Answer 5

• eGFR- measured by doing U&E
• Proteinuria
  
  • measured with urine albumin:creatinine ratio
• hAEMATURIA
  
  • 1+ on dipstix significant
• Renal USS

Question 6

what is a significant urine albumin:creatinine ratio finding?

Answer 6

>3mg/mmol

Question 7

complications of CKD?

Answer 7

• anaemia
• renal bone disease
• cardiovascular disease
• metabolic acidosis
• peripheral neuropathy

Question 8

when do you refer someone w CKD to a specialist?

Answer 8

eGFR < 30

Question 9

Mx?

Answer 9

• slow progression of disease
  
  • optimise glycaemic control / HT
  • treat GN
• reduce risk of complications
  
  • lifestyle measures
  • atorvastatin for primary prevention of CVD
• manage complications
  
  • anaemia- iron supplements first, then exogenous EPO
  • metabolic acidosis- sodium bicarbonate
  • bone disease- active vit D, low phosphate diet & bisphosphonates
  • end stage renal disease- dialysis / transplant

Question 10

what do you use to treat HT in someone w CKD?

Answer 10

ACEI

Question 11

what must you monitor in someone who is taking ACEI on a background of CKD?

Answer 11

K as BOTH can cause hyperkalaemia

Question 12

X-Ray changes in renal bone disease?

Answer 12

“rugger jersey” appearance of spine - denser white at both ends of vertebra (sclerosis) and less white in centre (osteomalacia)