Chronic kidney disease

Chronic kidney disease (CKD)

Chronic kidney disease (CKD) is defined by renal damage (albuminuria) and decrease in renal function (GFR < 60 ml/min) lasting more than three months. There is a gradual and progressive loss of the ability of the kidneys to excrete wastes and to maintain water, salt, electrolyte and acid-base balance, due to the loss of functional nefrons.

Causes of CKD include diabetic nephropathy, nephrosclerosis, glomerulonephritis, chronic interstitial nephritis (reflux, obstruction, sarcoidosis, Sjogren, drugs such as Lithium and 5-ASA) and polycystic disease.

Progression of CKD depends on the underlying cause and the presence of progression factors: hypertension, proteinuria, obesity, salt and protein rich diet, hyperuricemia, smoking and poor glucose control.

Hypertension as result of salt retention and renal activation of the renin-angiotensin and sympathetic system, is an early sign of CKD. Symptoms of fatigue due to anemia occur once renal function is less than one-third of normal. The uremic syndrome is a late manifestation of CKD due to the build-up of waste products.

A decreased production of erythropoietin by the fibrotic kidneys leads to anemia. Anemia then induces hypertrophy of the left ventricle and heart failure. The kidneys also slow down their vitamin D production, which results in secondary hyperparathyroidism and osteodystrophy. With a decreasing renal function, the potassium, mineral and acid-base balance becomes disturbed. This results in hyperphosphatemia, metabolic acidosis and hyperkalemia.

1

About drug-induced renal disease: which of the following associations is NOT true?

2

For microalbuminuria all of the following is true, EXCEPT…

3

Which of the following does NOT indicate a bad prognosis in IgA nephropathy?