🎓
CKD
Renal
Asymptomatic (routine screening)
Oedema
Pruritus
Chronic Kidney Disease (CKD) is defined as an abnormality in kidney structure or function persisting for >3 months. It is classified by GFR and albuminuria (ACR). Complications include anaemia and bone disease.
🎯 Key Learning Objectives
- Classify CKD using GFR (G1-G5) and Albuminuria (A1-A3) categories.
- Identify the primary causes (Diabetes, Hypertension, Glomerulonephritis).
- Manage blood pressure aggressively to slow progression.
- Manage complications such as renal anaemia and mineral bone disease (CKD-MBD).
- Identify when to refer to secondary care (cardiology/nephrology).
- Explain the cardiovascular risk associated with CKD.
🔬 Pathophysiology
Irreversible loss of nephrons leads to hyperfiltration in remaining nephrons, causing progressive fibrosis and sclerosis. Decreased erythropoietin production and impaired Vitamin D activation occur.
🩺 Clinical Features
Symptoms
- Often asymptomatic
- Fatigue (anaemia)
- Nausea
- Pruritus
- Nocturia
Signs
- Hypertension
- Pallor
- Peripheral oedema
- Skin excoriation
- Uraemic tinge
🔬 Investigations
🛏️ Bedside
- Blood pressure
- Urine ACR (first morning void preferred)
🩸 Bloods
- eGFR (Creatinine)
- HbA1c
- Full Blood Count (anaemia)
- Calcium/Phosphate/PTH
- Vitamin D
📷 Imaging
- Renal Ultrasound (check for polycystic kidneys or size <9cm)
⚗️ Special
- Renal biopsy (if proteinuria >1g/day or rapid decline)
💊 Management
🚨 Acute Management
- Not applicable (Chronic condition Management)
📋 Long-Term
- ACE-inhibitor or ARB (especially if proteinuria)
- SGLT2 inhibitors
- Statin (Atorvastatin 20mg)
- Erythropoietin (if Hb <110g/L)
🏃 Lifestyle
- Salt restriction (<2.4g sodium)
- Smoking cessation
- Exercise
- Weight management
⚠️ Complications
Renal anaemia
Renal osteodystrophy
Cardiovascular disease (major cause of death)
Fluid overload
Secondary hyperparathyroidism
⭐ High-Yield Pearls
- eGFR can be inaccurate in bodybuilders (high muscle mass) or amputees.
- NICE target BP in CKD: <140/90 (or <130/80 if ACR >70).
- Phosphate binders must be taken with meals to be effective.
- CKD patients are at higher risk of cardiovascular events than of reaching end-stage renal failure.
- The GFR 'G' and ACR 'A' are multiplied to determine the risk of progression.
📖 GUIDELINES:
NICE NG203
❓ Practice Questions
Q1. A 72-year-old man is admitted with a two-day history of vomiting and diarrhoea. His blood pressure is 95/60 mmHg and his heart rate is 105 bpm. Baseline creatin…
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Q2. A 65-year-old woman with chronic kidney disease (CKD) stage 4 is found to have a serum potassium of 6.8 mmol/L. Her ECG shows peaked T waves and a broadened QRS…
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Q3. A 45-year-old man presents with bilateral leg swelling and periorbital oedema. Urinalysis shows 4+ protein and 24-hour urinary protein is 4.5g. His serum albumi…
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