2: Adult Renal Disease

Question 1

What is the formula for urine albumin to creatinine ratio (UACR)?

Answer 1

UACR = urine albumine/urine creatinine

Question 2

ACEs or ARBs are most commonly paired with _____ to maintain BP in diabetics if more than 1 med is needed.

Answer 2

diuretics

Question 3

T/F ACEs and ARBs can be used in DM patients without HTN who have albuminuria to slow down CKD progression.

Answer 3

True

Question 4

What diagnostics would you consider for a hematuria workup (8)?

Answer 4

Initial UA with possible culture
Renal function tests
CBC
Sed rate
STI (PID, urethritis)
CT, U/S, renal angiography
Renal biopsy
Immunologic studies (evidence of gomerular damage with casts, heavy proteinuria)

Question 5

What is the GFR and/or albumin level in renal dz?

Answer 5

GFR <60

Albuminuria >30 mg/g of urinary creatinine

Question 6

If someone has multiple myeloma, what panels would you order?

Answer 6

Serum and immune electropheresis

Question 7

If someone has post-strep glomerulonephritis, what panels would you order?

Answer 7

Antistreptolysis-O titer
AntiDNAseB
Complement levels

Question 8

Be careful with ACEs/ARBs, sulfa meds, and _____ in patients with renal insufficiency.

Answer 8

lithium

Question 9

90% of drug-induced nephrotoxicity is caused by what 3 meds?

Answer 9

Aminoglycosides (ABX with -mycin endings)
NSAIDs
Contrast agents/meds

Question 10

If someone has Berger’s dz, what panel would you order?

Answer 10

Serum IgA

Question 11

T/F Closely monitor A1C and phosphorus in DM patients who are at risk or have CKD.

Answer 11

True

Question 12

In diabetics, measure serum _____ at least annually regardless of the degree of urine albumin excretion.

Answer 12

creatinine

Question 13

What do you look for in the UA with CKD?

Answer 13

Albuminuria

UACR

Question 14

What conditions increase risk for renal dz (5)?

Answer 14

DM
HTN
Polycystic dz
Trauma
OTC (ASA, tylenol, ibuprofen)

Question 15

Albuminuria is present when the UACR is > _____.

Answer 15

30 mg/g

Question 16

Who should be screened annually for urine albumin excretion?

Answer 16

DMT1
DMT2
DM 5 years or more

Question 17

From the case study in 2.8.1 (terribly broad question):

Renal question. What should the NP watch for?

Answer 17

1. Rising creatinine
2. Patients with hypertension and diabetes without good primary care
3. Patients who are seeking alternative therapies (meds that go through kidneys)
4. Patients on pain meds for some time
5. A routine urine that has protein or casts
6. Patients who are postsurgery or post a medical admission
7. Patients on numerous meds

Question 18

What is the initial treatment for diabetics with micro or macroalbuminuria?

Answer 18

ACE or ARB (if not pregnant)

Question 19

When would you not be concerned with RBCs on UA?

Answer 19

Seen with bacteria and/or WBCs indicates infx rather than renal. If RBC casts or marked proteinuria are present, then likely renal source.

Question 20

What are the albumin levels for:
Normal
Microalbuminuria
Macroalbuminuria

Answer 20

Normal <30
Microalbuminuria 30-299
Macroalbuminuria 300+

Question 21

CKD increases the risk of _____.

Answer 21

CVD. Risk of CVD is increased 1.4-2x with creatinine elevations over 1.4-1.5. Those with CKD should be considered one of the highest risk groups for CVD.

Question 22

To help prevent CKD in DM, maintain a BP of < _____ or < _____ if pt has proteinuria.

Answer 22

140/90

130/80

Question 23

T/F There is clinical trial support for using ACEs and ARBs in DM, HTN, and albuminuria to delay progression to nephropathy.

Answer 23

True. ACEs for DMT1 and ACEs and ARBs for DMT2.

Question 24

The _____ should be used to estimate the GFR and stage the level of CKD present.

Answer 24

serum creatinine

Question 25

Which ethnicities are at higher risk of CKD?

Answer 25

AA (3.8x)
Native Americans (2x)
Asians (1.3x)

Question 26

Optimizing _____ and _____ slows the progression of nephropathy in diabetics.

Answer 26

glucose

BP

Question 27

If someone has SLE, what panels would you order?

Answer 27

ANA
Anti-DNA antibody
Complement levels (C3/4)

Question 28

T/F ACEs and ARBs can be used in DM patients without HTN and/or albuminuria to prevent CKD.

Answer 28

False. They should not be used in normotensive normoalbuminuric patients with DM.