Chronic Kidney Disease
Also written as CKD.
Side effects: tremor, thirst and polyuria (nephrogenic diabetes insipidus), weight gain, hypothyroidism, hypercalcaemia (hyperparathyroidism), GI upset, chronic kidney disease.
CHRONIC KIDNEY DISEASE (CKD)
- Definition: Kidney damage or an eGFR <60 mL/min/1.73m² for ≥3 months.
- Causes: - Diabetic nephropathy (most common). - Hypertensive nephropathy (second most common). - Chronic glomerulonephritis. - Polycystic kidney disease (PKD). - Obstructive uropathy.
- Pathophysiology: Loss of nephrons leads to compensatory hyperfiltration in the remaining nephrons. This increased workload eventually leads to glomerulosclerosis and further nephron loss, creating a vicious cycle.
- Complications: - Anaemia: Due to decreased erythropoietin (EPO) production. - Secondary hyperparathyroidism: Due to decreased vitamin D activation and hypocalcaemia, leading to increased PTH. This can cause renal osteodystrophy. - Electroly
- Ultrasound findings: Typically show small, shrunken kidneys (<9cm), except in conditions like diabetes mellitus and PKD, where kidneys may be normal or enlarged.
Read this in Endocrine & Renal Pathology — Must Know Notes
CHRONIC KIDNEY DISEASE (CKD)
- Definition: eGFR <60 mL/min/1.73m² OR kidney damage markers for ≥3 months.
Read this in Endocrine & Renal Pathology
What our notes say
- Side effects: tremor, thirst and polyuria (nephrogenic diabetes insipidus), weight gain, hypothyroidism, hypercalcaemia (hyperparathyroidism), GI upset, chronic kidney disease. (Bipolar and Related Disorders)
- Topics tested: chronic kidney disease in children, nephrotic syndrome, vaccine-preventable diseases, cold chain. (Paediatrics and Child Health end of semester examination (MBPE): 10 January 2023)
- Topics tested: anaemias, iron studies, haemolysis, bleeding disorders, haemochromatosis, acute kidney injury, glomerular and tubulointerstitial disease, kidney stones, dialysis and chronic kidney disease staging. (Internal Medicine End of Semester CAT (MBChB 4): haematology and renal, 30 MCQs )
- Transudates: heart failure, cirrhosis, nephrotic syndrome, hypoalbuminaemia, chronic kidney disease, peritoneal dialysis, hypothyroidism. (Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 Januar)
- Modifiable risk factors for chronic kidney disease include: (Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019)
- In chronic kidney disease, start when the GFR falls below 15 with symptoms. (Internal Medicine (MBIM 4100) special/supplementary exam, Paper Two: 14 August 2)
Study material on Chronic Kidney Disease
- Chemical Pathology MCQs: Clinical Chemistry, Endocrine & Renal
- Chemical Pathology MCQs
- Endocrine & Renal Pathology
- Endocrine & Renal Pathology — Must Know Notes
- Chemical Pathology Practice Examination
- CLINICAL BIOCHEMISTRY LAQs & SAQs
- Internal Medicine (MBIM 4100) special/supplementary exam, Paper Two: 14 August 2019
- Internal Medicine End of Semester CAT (MBChB 4): haematology and renal, 30 MCQs and 3 short answers
- Approach to anaemia
- Chemical Pathology MCQs: Diabetes, Renal & Liver Disease
- Chemical Pathology MCQs
- Weekly Year 2: Microbiology Exam - May 29, 2026 (Sections B & C)
- CHEMICAL PATHOLOGY MCQs
Practice questions on Chronic Kidney Disease
A 52-year-old man with chronic kidney disease receives a renal allograft matched by tissue typing for HLA-DR (Class II) antigens. He does not develop rejection; his serum creatinine remains normal. Which immunologic abnormality has most likely been avoided by the tissue typing?
- Amyloidosis
- Cell lysis by CD8 lymphocytes
- Graft versus host disease
- CD4 lymphocyte activation
- Serum sickness
Answer: D. * Class II HLA antigens are central to CD4 lymphocyte activation, which drives much of the alloimmune response against a transplanted organ. ---
In chronic kidney disease, the most immediately life-threatening electrolyte abnormality is
- Hyponatremia
- Hypocalcemia
- Hyperkalemia
- Hyperphosphatemia
Answer: C. Hyperkalemia can cause fatal ventricular arrhythmias; impaired renal potassium excretion in CKD makes this the most urgent electrolyte emergency. ---
Which acid-base disorder is commonly seen in patients with chronic kidney disease?
- Metabolic acidosis
- Metabolic alkalosis
- Respiratory acidosis
- Respiratory alkalosis Correct
Answer: A. CKD causes metabolic acidosis due to decreased acid excretion, reduced ammonia production, and bicarbonate loss. ---
A 65-year-old man with chronic kidney disease presents with weakness and palpitations. ECG shows peaked T waves. Lab results: K⁺ 6.5 mmol/L, Na⁺ 140 mmol/L, BUN 55 mg/dL, Creatinine 4.2 mg/dL. What is the next best step?
- IV calcium gluconate
- Loop diuretics
- IV normal saline
- Oral potassium supplements Correct
Answer: A. Severe hyperkalemia with ECG changes (peaked T waves) is a cardiac emergency. IV calcium stabilizes cardiac membrane first. ---
A 70-year-old diabetic patient presents with chronic kidney disease. Labs: BUN 55 mg/dL, Creatinine 5.5 mg/dL, eGFR 15 mL/min. What stage of CKD is this?
- Stage 1
- Stage 3
- Stage 4
- Stage 5 Correct
- Stage 5
Answer: D. eGFR <15 mL/min indicates Stage 5 CKD (kidney failure), requiring renal replacement therapy consideration. ---
A patient with secondary hyperparathyroidism due to chronic kidney disease will have
- High calcium
- Low phosphate
- High PTH
- High vitamin D Correct
Answer: C. CKD causes phosphate retention and vitamin D deficiency, leading to low/normal calcium and compensatory PTH elevation. ---