14 - CKD

Question 1

4 parts of the final common pathway of CKD

Answer 1

glomerular sclerosis
tubular atrophy
interstitial fibrosis
vasculosclerosis

Question 2

gross pathologic changes in CKD

Answer 2

contracted kidneys
thin renal cortex
multiple cysts (acquired cystic dz)

Question 3

4 main interventions to slow progression of CKD

Answer 3

control glomerular pressure
low protein diet
BP control
ATII axis control

Question 4

benefit of low protein diet in CKD

Answer 4

lowers glomerular pressure

Question 5

3 main causes of ESRD

Answer 5

DM
HTN
glomerulonephritis

Question 6

results of renal failure (lab findings)

Answer 6

high BUN and Cr
fluid retention
hyponatremia
hyper/hypo kalemia
acidosis
hyperphosphatemia
low Vit D > hypocalcemia
anemia
hypoglycemia etc

Question 7

ESRD symptoms

Answer 7

tired, apathy, itching, copper penny taste
N/V anorexia, wt loss
pericarditis, uremic myocarditis
peripheral nerve inc conudction time, axonal loss, demyelination
paresthesia, restless leg syndrome, cramps
confusion, eventually coma/seizures

Question 8

ESRD management

Answer 8

Na restriction / diuretics
cinacalcet, phosphate binders, limit PO4 intake (complicated to balance Ca vs PO4 vs bone dz)
EPO (goal Hgb 10-12)
dialysis (avoid as long as possible)

Question 9

indications for dialysis

Answer 9

GFR ~10
can wait if stable or gaining weight (not from edema), good protein intake, no signs of uremia
earlier initiation may be better for diabetics (GFR ~15)