2: Adult Renal Disease Flashcards
What is the formula for urine albumin to creatinine ratio (UACR)?
UACR = urine albumine/urine creatinine
ACEs or ARBs are most commonly paired with _____ to maintain BP in diabetics if more than 1 med is needed.
diuretics
T/F ACEs and ARBs can be used in DM patients without HTN who have albuminuria to slow down CKD progression.
True
What diagnostics would you consider for a hematuria workup (8)?
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)
What is the GFR and/or albumin level in renal dz?
GFR <60
Albuminuria >30 mg/g of urinary creatinine
If someone has multiple myeloma, what panels would you order?
Serum and immune electropheresis
If someone has post-strep glomerulonephritis, what panels would you order?
Antistreptolysis-O titer
AntiDNAseB
Complement levels
Be careful with ACEs/ARBs, sulfa meds, and _____ in patients with renal insufficiency.
lithium
90% of drug-induced nephrotoxicity is caused by what 3 meds?
Aminoglycosides (ABX with -mycin endings)
NSAIDs
Contrast agents/meds
If someone has Berger’s dz, what panel would you order?
Serum IgA
T/F Closely monitor A1C and phosphorus in DM patients who are at risk or have CKD.
True
In diabetics, measure serum _____ at least annually regardless of the degree of urine albumin excretion.
creatinine
What do you look for in the UA with CKD?
Albuminuria
UACR
What conditions increase risk for renal dz (5)?
DM HTN Polycystic dz Trauma OTC (ASA, tylenol, ibuprofen)
Albuminuria is present when the UACR is > _____.
30 mg/g
Who should be screened annually for urine albumin excretion?
DMT1
DMT2
DM 5 years or more
From the case study in 2.8.1 (terribly broad question):
Renal question. What should the NP watch for?
- Rising creatinine
- Patients with hypertension and diabetes without good primary care
- Patients who are seeking alternative therapies (meds that go through kidneys)
- Patients on pain meds for some time
- A routine urine that has protein or casts
- Patients who are postsurgery or post a medical admission
- Patients on numerous meds
What is the initial treatment for diabetics with micro or macroalbuminuria?
ACE or ARB (if not pregnant)
When would you not be concerned with RBCs on UA?
Seen with bacteria and/or WBCs indicates infx rather than renal. If RBC casts or marked proteinuria are present, then likely renal source.
What are the albumin levels for:
Normal
Microalbuminuria
Macroalbuminuria
Normal <30
Microalbuminuria 30-299
Macroalbuminuria 300+
CKD increases the risk of _____.
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.
To help prevent CKD in DM, maintain a BP of < _____ or < _____ if pt has proteinuria.
140/90
130/80
T/F There is clinical trial support for using ACEs and ARBs in DM, HTN, and albuminuria to delay progression to nephropathy.
True. ACEs for DMT1 and ACEs and ARBs for DMT2.
The _____ should be used to estimate the GFR and stage the level of CKD present.
serum creatinine
Which ethnicities are at higher risk of CKD?
AA (3.8x)
Native Americans (2x)
Asians (1.3x)
Optimizing _____ and _____ slows the progression of nephropathy in diabetics.
glucose
BP
If someone has SLE, what panels would you order?
ANA
Anti-DNA antibody
Complement levels (C3/4)
T/F ACEs and ARBs can be used in DM patients without HTN and/or albuminuria to prevent CKD.
False. They should not be used in normotensive normoalbuminuric patients with DM.
