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Senior - GU Test 1 > 12 - CKD > Flashcards

12 - CKD Flashcards

1
Q

National kidney foundation (NKF) defines CKD as?

A 
Evidence of renal damage based on:
- abnormal UA (protein, heme)
Or
- structural abnormality by US
Or
- GFR <60 mL/min

For >3 months

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2
Q

Stages of CKD?

A

1: GFR >90
- damage
2: GFR 60-89
- mild
3: GFR 45-59
- mild - moderate
4: GFR30-44
- moderate - severe
5: GFR < 15
- ESRD

Chart on slide 8

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3
Q

KDIGO guidelines

CKD definition?

A

Abnormalities of kidney structure of function persistent > 3 months

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4
Q

KDIGO guidelines CKD classification?

A

Based on GFR and albuminuria

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5
Q

MC risk factors for CKD?

A 
DM
HTN
Vascular disease
FHx of CKD
>60yo
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6
Q

Maj outcomes of CKD?

A 
CVD
Complications of Impaired renal function
- anemia
- DO of mineral metabolism
- 2ndary hyperparathyroidism
ESRD
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7
Q

Major causes of CKD?

A 
Primary glomerular diseases
Secondary glomerular diseases
Tubulointerstitial nephritis
Cystic disease
Obstructive nephropathies
Vascular disease

Examples on slid 12

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8
Q

Pathophys of CKD?

A

L clearance of certain solutes principally excreted by the kidney results in their retention in body fluids

Reduction in renal mass (nephron destruction)

  • hypertrophy of remaining nephrons
  • hyper-filtration
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9
Q

Symptoms of CKD?

A

Develop slowly and are nonspecific

Early stages - asymptomatic

Symptomatic once GFR <5-10

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10
Q

CKD physical findings

A 
Chronically ill-appearing
HTN
Dermatologic manifestations
Uremic fetor 
Mental status changes
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11
Q

What are mee’s lines?

A

Seen with the dermatologic manifestions of CKD

They are finger nail changes

Pic on slide 19

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12
Q

What is uremic fetor?

A

Urinous breath

Halitosis

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13
Q

UA findings for CKD?

A

Broad, waxy casts (stasis)
Persistent proteinuria
- persistent proteinuria - (CKD no matter the GFR)

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14
Q

CKD serum findings?

A 
H BUN/Cr (persistent)
L GFR (<60)
Anemia
Metabolic acidosis
Hyperphosphatemia
Hyperkalemia
Hypocalcemia
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15
Q

Caution when using serum creatinine to track CKD because?

A

Serum creatinine may remain normal until there has been a severe decline in GFR

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16
Q

imaging with CKD?

A

US - small (<9-10cm)

Radiology - evidence of renal ostedostrophy

  • phalanges of hands
  • clavicles
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17
Q

Complications of uremia

A
  • Cardiovascualr - (50% of deaths in pts w ESRD)
  • Disorders of mineral metabolism
  • Hematologic
  • Hyperkalemia
  • Acid-base disorders (metabolic acidosis)
  • Neurologic
  • Endocrine disorders
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18
Q

CKD cardiovascular complications?

A

HTN
CHF
Uremic pericarditis

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19
Q

MC CKD complication?

A

HTN

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20
Q

Lifestyle changes for HTN pts?

A

Decrease salt (2g/day)
Diuretic - Thiazide/loop
ACEI/ARB

Goal BP <140/90 mmHg

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21
Q

CKD and CHF?

A

A chain of events

CKD causes HTN (RAAS stimulation), volume overload, anemia

  • Lead to higher cardiac workload
  • accelerated atherosclerosis

contributes to LVH and HF

22
Q

uremic pericarditis presentation?

A

S/s - pleuritic chest pain/fever
PE - pulsus paradoxus and friction rub
ECG - low voltage, electrical alternans
CXR - enlarged cardiac silhouette

23
Q

Pericarditis is?

A

An absolute indication for hemodialysis and hospitalization

24
Q 
CKD pts (esp those w DM) will likely die from
?
A

CVD is much more likely than ESRD

CKD - look at heart
Heart disease - look at kidney

25
Low GFR and small kidneys have what effect on mineral metabolism?
Osteitis fiberosa cystica (H PTH) Adynamic bone disease (L PTH) Osteomalacia (L vit D)
26
MC mineral disorder from CKD?
Osteitis fibrosa cystica | - secondary hyperparathyrodism -> osteoclast stimulating effects of PTH
27
Why does CKD lead to bone problems?
Hserum phosphorus (hyperphosphatemia L vitamin D -> (hypercalcemia) H PTH (secondary hyperparathyrodism) -> Renal osteodystrophy (bone disease)
28
Tx for mineral metabolism do?
Hyperphosphatemia control - phosphorus restriciton - phosphorus binding agents Hyperparathyrodism tx - vit D - Calcitriol
29
Hematologic complications of CKD?
Anemia - normochromic, normocytic - low erothropoietin - low iron absorption Coagulopathy - platelet dysfunction - > petechia/purpura - > bleeding
30
Dialysis effect on bleeding?
Improves bleeding time but doesnt normalize it
31
CKD and hyperkalemia?
Potassium balance remains intact until GFR < 10-20ml/Min (CKD stages 4-5)
32
Acute hyperkalemia needs?
- Cardiac monitoring - IV calcium chloride or gluconate - Insulin w glucose - Bicarbonate - Sodium polystyrene sulfonate
33
Chronic Hyperkalemia needs?
- Dietary potassium restriction | - Sodium polystyrene PRN
34
Damaged kidneys lead to what acid-base do?
Inadequate acid (H+) excretion -> metabolic acidosis
35
Acid-base d/o tx?
Maintain/normalize serium bicarb level: >21 mEq/L - alkali suppliments Keep pH >7.20
36
Neurologic complications?
Uremic encephalopathy - GFR <5-10 Peripheral neuropathies
37
Endocrine complications of CKD?
H insulin (hypoglycemia) L libido and ED (common)
38
CKD management
``` Tx underlying cause - esp DM Meds - ACEI/ARB, statin, diuretics Consult - CKD clinics (goal - stay off dialysis) Pt eduction - smoking Diet restrictions - protein - salt/water - k+ - phosphorous ```
39
CKD pts need to be evaluated by?
Nutritionist
40
Once CKD -> ESRD pts need?
RRT - renal replacement therapy - hemodialysis - peritoneal dialysis - kidney transplant
41
Indications for RRT?
``` GFR <5-10 Uremic symptoms (pericarditis, coagulatpathy etc) Fluid overload Refractory hyperkalemia >7 Severe metabolic acidosis (pH <7.2) Neurologic symptoms BUN >100 ```
42
Problems w hemodialysis?
Vascular access complications - infection, thrombosis, aneurysim 3 sessions/wk - 3-5 hrs each (15hrs/wk)
43
What is peritoneal dialysis?
Peritoneal dialysis is a type of dialysis that uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood.
44
types of peritoneal dialysis?
CAPD - continuous ambulatory peritoneal dialysis - MC type - pt swaps bags out throughout the day CCPD - continusous cyclic peritoneal dialysis - machine works at night
45
Which type of kidney transplant is best?
Living donor is much better 1 yr survival - 95% living donor - 89% deceased 5 yr - 80% living donor - 66% deceased
46
Life expectancy for dialysis pts?
5 yr survival? - 40% Average life expectancy 3-5 yrs (though sometimes up to 25 yrs)
47
Causes of death for CKD pts?
Cardiac disease (50%) Infection Cerebrovascular disease Malignancy
48
Bottom line for CKD pts?
Medical care is based on delaying/halting CKD progression
49
With CKD pts always?
Be cognizant of necessary dose adjustments when prescribing meds
50
Dont worry
Urine good hands

Senior - GU Test 1 (13 decks)

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