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Q1: Definition and staging (2 min)
- CKD: kidney damage markers or eGFR <60 for >3 months[1][2]
- G stages G1–G5 by eGFR; A1–A3 by albuminuria (UACR <30 / 30–300 / >300 mg/g)[1][2]
- Risk heat map uses G×A; albuminuria is independent risk even if eGFR normal[1][2]
Q2: Causes and progression (2 min)
- Common: diabetic kidney disease, hypertensive nephrosclerosis, chronic GN, ADPKD, obstructive uropathy, reflux[1][2]
- Progression drivers: ongoing albuminuria, hypertension, hyperglycaemia, smoking, NSAIDs, recurrent AKI[1][2]
- Measure trajectory (eGFR slope) not single value
Q3: Disease-modifying therapy with doses (3 min)
- ACEI/ARB maximally tolerated for albuminuric CKD
- SGLT2i: dapagliflozin 10 mg or empagliflozin 10 mg (DAPA-CKD, EMPA-KIDNEY)[1][2]
- Finerenone in T2DM with CKD/albuminuria if K⁺ allows[1][2]
- Statin for ASCVD risk; BP usually <130/80; glycaemic optimisation[1][2]
- Avoid dual RAAS blockade; stop nephrotoxins
Q4: Anaemia of CKD (2 min)
- Multifactorial: EPO deficiency, iron deficiency, inflammation, B12/folate, blood loss[1][2]
- Correct iron first; ESA only after iron replete
- Hb target ~100–120 g/L; do not normalise to >130 (stroke risk)[1][2]
Q5: Hyperkalaemia emergency (3 min)
- ECG changes → calcium gluconate 10 mL 10% IV
- Shift: insulin 10 U + glucose; nebulised salbutamol
- Remove: binders, diuretics if residual urine, dialysis if needed[1][2]
- Review ACEI/ARB/MRA/trimethoprim/NSAIDs
Q6: CKD-MBD and other complications (2 min)
- Hyperphosphataemia, secondary hyperparathyroidism, hypocalcaemia/high FGF23 → vascular calcification[1][2]
- Volume overload, metabolic acidosis, uraemic symptoms, CV death (leading cause)[1][2]
- Vaccinate (hep B, influenza, pneumococcal) as per local protocol[1][2]
Q7: Renal replacement and referral (2 min)
- Refer early (typically eGFR <30 or progressive/complex disease)[1][2]
- RRT options: HD, PD, transplant (best long-term if eligible)[1][2]
- AEIOU dialysis indications; advanced care planning for conservative pathway[1][2]
References3ShowHide
- [1]Levin A, Ahmed SB, Carrero JJ, et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns Kidney Int, 2024.PMID 38519239
- [2]Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy N Engl J Med, 2019.PMID 30990260
- [3]Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease N Engl J Med, 2020.PMID 32970396