CKD

• What is CKD?


  Abnormal kidney function or structure for > 3 months

  Includes decreased GFR (< 60) or markers of kidney damage (albuminuria, electrolyte abnormalities, structural or histological renal abnormalities)
• How can CKD be staged?


  Based on

  • eGFR
  • Albuminuria
• CKD staging - based on eGFR


  G1: eGFR > 90

  G2: eGFR 60-89

  G3a: eGFR 45-59

  G3b: eGFR 30-44

  G4: eGFR 15-29

  G5: eGFR < 15
• CKD staging - based on albuminuria


  A1: ACR < 3

  A2: ACR 3-30

  A3: ACR > 30

  ACR = albumin:creatinine ratio
• What are the RFs for CKD?

  Diabetes

  HTN

  Hx of AKI

  CVD

  Structural renal disease

  Systemic disease (SLE)

  Gout

  FHx of CKD

  Haematuria or proteinuria
• What are the Inx of CKD?


  Obs

  Full Hx & examination

  Urine dip & MSU

  Bloods (FBC, U&Es, LFTs, CRP, HbA1c, bone profile, bicarbonate)

  Renal USS

  'Renal screen' & kidney biopsy may be undertaken if cause of CKD is not clear
• What are the causes of CKD?


  Glomerular causes

  • primary (IgA nephropathy)
  • secondary (SLE)

  Vascular causes

  • vasculitis
  • RAS

  Tubulointerstitial causes

  • amyloidosis
  • myeloma

  Congenital causes

  • polycystic kidney disease
  • Alport syndrome

  Systemic causes

  • diabetes
  • HTN

  Developmental causes

  • vesico-ureteric reflux -> chronic pyelonephritis
• What are the possible complications of CKD?

  CRF HEALS

  CVD

  Renal osteodystrophy

  Fluid (oedema)

  HTN

  Electrolyte disturbance (hyperkalaemia, acidosis)

  Anaemia

  Leg restlessness (uraemia)

  Sensory neuropathy (uraemia)
• What is the management & treatment of CKD?


  Preserve kidney function

  • maintain healthy weight
  • ? smoking cessation
  • maintain healthy BP
  • control diabetes
  • ACEi or ARBs (renoprotective)

  Manage complications

  • manage anaemias
  • decrease salt intake
  • CKD-mineral bone disorder -> phosphate restriction, phosphate binders & vitamin D

  Dialysis

  Kidney Transplant
• What are the symptoms of CKD?


  Often asymptomatic until later stages

  Lethargy

  Anorexia

  Headaches

  Weight loss

  Nausea/vomiting

  Itching

  SOB

  Muscle cramps (eps at night)

  Bone pain

  Taste changes

  Cognitive impairment

  Polyuria/Oliguria

  Nocturia

  Frothy urine (due to proteinuria)
• What are the signs of CKD?


  HTN

  Pallor

  Abnormal fluid status

  Fluid overload with oedema

  Dehydration

  Cachexia

  Ammonia-like smelling breath

  Tachypnoea

  Flank masses
• What are the DDx of CKD?


  AKI

  False-positive low eGFR results

  Urinary ACR
• Pathophys - CKD


  Complex

  Renal injury -> increase in intra-glomerular pressure w/glomerular hypertrophy -> increase in glomerular permeability -> toxicity to mesangial matrix -> mesangial cell expansion, inflammation, fibrosis & glomerular scarring -> increase angio II production -> upregulation of TGF-beta -> collagen synthesis & renal scarring within glomerulus