Chronic Kidney Disease

Definition
Defined by the presence of kidney damage or decreased kidney function for three or more months, irrespective of the cause

Staging
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Kidney Damage with normal/increase eGFR >90
Kidney Damage with mildly reduced eGFR 60-89
Moderately reduced eGFR 30-59
Severely reduced eGFR 15-29
Kidney Failure <15
KIDNEY DAMAGE
Persistent Proteinuria/Microalbuminuria
Persistent Haematuria
Changes on Renal Imaging (Structural Abnormalities)

Detecting early CKD
Spot Urine Albumin Creatinine Ratio >30mg/g

Presentation of CKD
Urea: Anorexia, Fatigue, Gout, Pruritis, Confusion, N/V, Restless leg, Chest pain (pericarditis)
Fluid: Oedema, Weight gain
Acid: SOB
Potassium: Palpitations, Syncope
Vitamin D: Bony pains, Fractures
EPO: Fatigue, SOB, Pallor
B2 microglob: Peripheral neuropathy
Anorexia
Fatigue
Pruritis
Oedema
Pains
Numb feet
N/V

Investigations
Bloods: FBC
U+E
eGFR
Bone
Urate
PTH
Urine: Dipstick
MC+S
ACR
Urinalysis
Imaging: USS
X-ray KUB
2nd Line Investigations
CT Abdomen
Angiography
Renal Biopsy

Management
CONSERVATIVE
Education (leaftlet and BKPA)
Renal diet
- Low fluid, sodium, potassium and phosphate
Avoid renotoxic drugs (but keep ACEi)
Cardiovascular Risk Factor addressing
MEDICAL
See Next Slide
ESRF
Haemodialysis
Continuous Ambulatory Peritoneal Dialysis
Transplant

EPO
Low Ca
High PO4
Bone Health
Vit D
Urea/Pruritis
Fluid
DON’T FORGET CARDIOVASCULAR RISK FACTORS

Specific Treatments to Rote Learn
CARDIOVASCULAR RISK +++ Statins, ACEi, Advice
ANAEMIA EPO
BP CONTROL ACEi (not in RAS)
OSTEOPOROSIS Bisphosphonates
VITAMIN D alfacalcidol/Calcitriol
HYPOCA++ Ca++ Supplements
HYPERPO4- Calcium Carbonate
OEDEMA Diuretics, Fluid/Na restrict
PRURITIS Cholestyramine
RESTLESS LEG Clonazepam
Note these factors together lead to the parathyroid
response responsible for renal bone disease

Renal Replacement Therapy
CAPD
“Peritoneum is used as a semi-permeable membrane”
Instill 3L isotonic fluid 4x/day and allow 30mins for exchange
NB: Infrequently add glucose to dialysate to remove water
Haemodialysis
NB: Uses serial weights to measure water removal