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CPR M2T1E3 > #19 Press - Chronic Kidney Disease > Flashcards

#19 Press - Chronic Kidney Disease Flashcards

1
Q

What is the overall prognosis for a patient with Acute Kidney Injury?

A

generally reversible

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2
Q

You suspect your patient has a decreased glomerular filtration rate. What would you use to confirm?

A

Creatinine based formula

CKD Epi

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3
Q

How would you stage a patient with a GFR of 45?

A

Stage 3

GFR 30-59

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4
Q

How would you manage a patient with uremia?

A

dialysis
renal transplant
treat anemia

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5
Q

What is the overall prognosis of a patient with chronic kidney disease?

A

Generally not reversible
- onset over months to years
Need three values over time.

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6
Q

What is the appearance of the kidney in a person with chronic kidney disease?

A

Small kidneys
increased echogenicity
(if large - Diabetic nephropathy)

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7
Q

A patient’s labs come back with a GFR less than 60. What comorbidities are they likely to have?

A 
Anemia
Secondary hyperparathyroidism (2*HPTH)
Malnutrition
Acidosis
Hypercalcemic
Cardiovascular (LVH)
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8
Q

Which measure would you use to determine stage, GFR or creatinine?

A

GFR

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9
Q

At what GFR rate is CKD diagnosed?

A

Under 60 mL/min/1.73m^2

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10
Q

HG comes in for a visit complaining of frequency and nocturia. During the history you discover he has been taking large amounts of ibuprofen for his knee pain. The urinalysis comes back with mild proteinuria. What is the ddx?

A

Chronic interstitial nephritis

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11
Q

During a physical exam of a 60 year old, you notice a femoral and carotid bruit. After labs you diagnose him with ischemic nephropathy. What is the etiology?

A

renovascular disease
Risk factors: white, smoker, over 50
Difficult to control HTN
-may have recurrent pulmonary edema

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12
Q

A patient comes in with acute hypertension and otherwise unexplained renal insufficiency. They are currently on an ACE inhibitor. What would you suspect?

A

Ischemic nephropathy

Due to blocking of efferent arterioles

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13
Q

HY comes in with a diverticular disease and valvular disorder. She also has a history of UTIs. She has a decline in GFR. You send her in for an ultrasound to look for what genetic defect?

A

ADPKD
Defect of chromosome 16 resulting in abnormal formation of cysts
Beware of intra-cerebral berry aneurysm Get MRA

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14
Q

When patients come into your office, what risk factors are you looking for developing CKD?

A 
HTN
Cardiovascular
DM
>60Y
Family history
Recurrent UTIs
Drugs - NSAIDS, antibiotics, contrast agents
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15
Q

OE just completed a 24 hour protein collection. How would you classify OE if his albumin was 190 mg/day?

A

Microalbuminuria (30-300 mg/day) more sensitive

[Macro >300mg/day]

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16
Q

What is the best way to quantify proteinuria?

A

uP/uCr ratio

If p/cr = 0.500 (500 mg/day)–> proteinuria

17
Q

The dipstick proteinuria came back positive but your nurse says it is may be a false positive. What do you suspect she noticed on labs?

A

Alkaline urine (pH>7.5)
or
Gross hematuria present
[False negative –>light chain protein or dilute urine]

18
Q

The urinalysis results come back with trace urine. Would you be concerned?

A

It would depend on how much urine is being produced by the patient. If the amount is 15 mg/dl and the patient is producing 2 liters a day that is 300 mg which is abnormal.

19
Q

What can you do to slow progression of CKD?

A

control BP 140/90

Reduce proteinuria

20
Q

What is the guideline for managing LDL levels in a CKD patient?

A

less than 70

21
Q

When would you initiate the work up of anemia in CKD?

A

Stage 3 CKD
Less epo –> anemic
Hgb

22
Q

Your patient with CKD is being evaluated for anemia. What would you want to know?

A 
Hgb, Hct, RBC indices, reticulocyte count
Iron Evaluation:
- serum iron
- TIBC
- percent transferrin saturation
- Serum ferritin
Test for occult blood in stool
23
Q

How would you differentiate primary and secondary hyperparathyroidism?

A

Both have elevated PTH
1* - hypercalcemic
2* - hypocalcemic

24
Q

What is your PTH goal for stage 3 CKD?

A

35-70 pg/mL

25
Q

How would you manage a patient with hyperparathyroidism?

A

In CKD, resrict dietary phosphate, phosphate-binding agents, supplement with Vit D, calcimimetics (sensipar) turn PTH off

26
Q

What type of acid/base balance is usually found in CKD?

A

Metabolic acidosis

Goal: HCO3 >22mmHG

27
Q

What constitutes uremia?

A

GFR 10-15
More than one:
Renal failure, lethargy, anorexia, dysgeusia, pericarditis, neuropathy, N/V, pruritis, dyspnea

28
Q

When would you start dialysis?

A

AEIOU (Acidosis, Electrolytes, Intoxicants, Overload, Uremia)
GFRDM
non-DM
Symptoms of uremia

CPR M2T1E3 (20 decks)

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