Chronic Kidney Disease – Peer Support Handout
Normal physiology of the kidney:
 Hormonal – erythropoietin, angiotensin, vit D metabolites
 Metabolite excretion – phosphate, urea, creatinine
 Homeostasis – acid base balance, electrolytes
CKD definition: a progressive decline in renal function over a period of months – years
*Decline in function must have been present for at least 3 months
Aetiology:
Disease type
Congenital
Glomerular
Vascular
Tuberointerstitial
Urinary tract obstruction
Specific pathology
PCKD
Obstructive uropathy
Tuberous sclerosis
Primary – focal glomerulosclerosis
Secondary – SLE, diabetic glomerulosclerosis, sickle cell,
thrombotic thrombocytopenic purpura
Reno-vascular disease (RAS)
Small and medium vessel vasculitis
Reflux nephropathy
TB
Schistosomiasis
Nephrocalcinosis
Multiple myeloma
Prostatic disease
Pelvic tumours
Calculi
Basically your main risk factors for developing CKD come from diabetes, hypertension and atherosclerosis.
Clinical features:
Early stages are completely asymptomatic.
As urea and creatinine levels increase symptoms start to present.

Malaise, anorexia, fatigue

N+V+D

Nocturia and polyuria

Pruritis

Bone pain (due to metabolic bone disease)

Peripheral oedema
Physical examination:
This may reveal the following:
Pallor – due to anaemia (EPO low)
High BP – due to fluid overload and RAS activation
Scratch marks – due to uraemia > pruritis
Fluid overload – oedema, regurgitation murmurs
Uraemic frost – urea is lost via sweat glands and accumulates on skin surface
Classification:
CKD is a spectrum of mild to very severe disease. We are able to assign a stage of CKD by measuring serum creatinine and
GFR.
GFR is a measure of how well the kidneys are excreting waste products. Creatinine is often used as a marker of disease; the
higher it is the lower the GFR.
Investigations:
Urinanalysis:
 Haematuria
 Proteinuria
 Culture
Urine microscopy:
 WCC
 Casts
Urine biochemistry:
 24 hour creatinine clearance
 Osmolality
Blood count:
 Eosinophils
 ESR
 Thrombocytopenia
Immunology:
 Complement
 Autoantibody screen
Radiological:



Biopsy
USS
CT
MRI
Management of CKD:
Identify those at risk and protect:

ACEi

ARB

Diuretics

CCB

Statins
Treat any underlying cause
There is no treatment as such for CKD – we just want to slow it down as much as possible – the drugs above do this. When
stage is 4 you need to start considering renal replacement therapy;
 Peritoneal dialysis
Can be done at home and encourages autonomy over care
 Haemodialysis
Requires hospital visits and fistula creation
 Transplantation
Risk of rejection
Lifetime drug therapy
If left untreated CKD can cause a number of secondary diseases.
Anaemia:
The main cause of this is the kidneys lose their hormone producing function and so less EPO is produced, meaning less
RBC’s are produced.
Metabolic bone disease/ Renal osteodystrophy:
Again loss of hormone production means less 1-alpha-hydroxylase which allows the production of active vit. D.

Need vitamin D for calcium absorption

Less vitamin D (and calcium) leads to stimulation of parathyroid glands

More PTH is produced

PTH causes resorption of calcium from bones

Associated with osteoporosis, osteomalacia and adynamic bone disease
Cardiac:
High risk of CVD, mainly due to development of hypertension and calcification/atherosclerosis.
Others:
High urate > gout
Endocrine abnormalities – thyroid hormone dysfunction, hyperprolactinaemia