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PDAT3 > 22 - CKD 1 > Flashcards

22 - CKD 1 Flashcards

1
Q

Normal GFR levels

A

Adjusted for BSA

Males
130 mL/min/1.73m2

Females
120 mL/min/1.73m2

To Accurately Asses GFR, Use a substance that is most ideal:
Freely filterable across glomerular membrane
Neither absorbed nor secreted by renal tubules
NOT metabolized nor produced by kidneys
EX:
inulin / iothalamate / iohexol

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2
Q

CrCl

Estimation of GFR & Factors that Affect

A

End product from muscle catabolism
directly related to muscle mass, extremes are NOT accurate

OVERESTIMATES GFR
by 15-20% (CrCl > GFR)

Factors Affecting SrCr:
Age / Gender / Race
Diet / Body Habitus / MEDS

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3
Q

Cockroft Gault Equation

A
  • *Uses CrCl to ESTIMATE GFR** (Overestimates)
  • *most commonly used, but least accurate**
  • *(140 - age) x (wt in kg)** x (0.85 if female)
  • *(72 x SCr**)
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4
Q

Definition of CKD

Defined 3 ways:
Cause
GFR Category
Albuminuria

A

Abnormal Function
(decrease in GFR < 60 mL/min/1.73 m2)
OR
Structure of Kidney for > 3 months

Albuminuria > 30 mg/day
Presence of hematuria or Red Cell Casts in urine sediment
Electrolyte and other abnormalities due to tubular disorders
Abnormalities detected by histology
Structural abnormalities by imaging
History of KIDNEY TRANSPLANTATION

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5
Q

Risk Factors for CKD

A

DM
HTN / Proteinuria / AKI
Immunological Disorders / OBESITY

SMOKING / High protein diet / Metabolic Acidosis

AA / Native American / MALE / Older age

HyperPHOS / HyperURICEMIA / Obstruction

Pregnancy / FAMILY HISTORY of DM/CKD/ESRD

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6
Q

CAUSES of CKD

A

Primary Causes:
DIABETIC NEPHROPATHY** & **HyperTensive Nephrosclerosis

Less frequent:
Primary Glomerular Disease = IgA nephropathy
Secondary Glomerular Disease = Lumpus Nephritis
HIV / Transplantation
Tubulointerstitial / vascular / cystic / herdetiary DISEASE

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7
Q

Diabetes & CKD

A

Damage done DIRECTLY through:
Hemodynamically
RAAS activation
Increased: Vasoconstriction of E-ferrent Arteriole
Increased: Glomerular HYPERfiltration
Podocyte destruction -> Albuminuria

Inflammation
Induces TNF-a + IL1/6/18
Also mediated by RAAS

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8
Q

Proteinuria

What defines:
MICROalbuminuria vs MACROalbuminuria

A

Large proteins –> can NOT pass through glomerulus filter

DESTRUCTION of PODOCYTES + Filtration Barrier
allow for proteins to leak out into glomerular filtrate
VVV
overwhelms proximal tubule to reabsorb this

MICROalbuminuria = 30-300 mg/day

MacroAlbuminuria = >300 mg/day

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9
Q

How to assess
PROTEINURIA

A

Measure:
SPOT URINE TEST / Early Morning Urine Sample

Assess:
ALBUMIN / CREATININE RATIO = P/C Ratio
albumin = most important protein loss

Damage if total:
P/C ratio > 200 mg/g

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10
Q

Treatment for PROTEINURIA

A
  • *ACE-I_ / _ARB**
  • *renoprotective, give even if normotensive**
  • not in combination with one another*

INHIBIT vasoconstriction of E-ferrent Arteriole

Also important to: REDUCE NA INTAKE

  • *+Aldosterone Antagonist may help**
  • but increase in K*

DO NOT combine with DIRECT renin inhibitor (aliskiren)

second line is non-diphydropyridine CCBs

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11
Q

HTN & CKD

A

Failure of:
Primary Protection via Autoregulatory Responses

Changes in:

  • *Extrarenal** & Renal Vasculature
  • breakdown of ELASTIC FIBERS* in arterial circulation

NEPHROSCLEROSIS
Narrowing of pre-glomular arteries & arterioles –> decreased glomerular blood flow

  • *GLOMERULOSCLEROSIS**
  • *Glomerular HTN & HYPERfiltration**
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12
Q

KDIGO

Staging of CKD

G1-G5

A

Also based on Albuminuria

<30 = normal

30-300 = Micro

300> = Macro

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13
Q

Signs of CKD

A

Edema / ANEMIA

Decreased Urine Output / FOAMING of urine

Abdominal Distention

Electrolyte Abnormalities:
K / Na / Phos / Ca
Uric Acid / Metabolic Acidosis

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14
Q

Symptoms of CKD

A

CHF, HTN // Fatigue, weakness, SOB

Mental confusion, N/V Itching

Cold intolerance // Hypoglycemia

Loss of appetite and malnutrition, weight gain

Peripheral neuropathies // HL

Sexual dysfunction, loss of menstruation

Muscle weakness, renal osteodystrophy

Uremia - Uremic Syndrome

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15
Q

Uremia

A

Azotemia associated with Clinical S/Sx

1) Diminished Excretion of E- & water
2) Decreased excretion of uremic toxins (organic solutes)
3) decreased synthesis of renal hormones
4) Maladaptive changes due to compensation

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16
Q

Uremic Syndrome

A

SYMPTOMS
resulting from the accumulation of nitrogenous waste products

secondary to RENAL FAILURE

17
Q

Nephrotic Syndrome

A

Defined as:

Urine Albumin > 2200 mg/day
or
Urine protein Excretion > 3000 mg/day

Generally:
GFR is 10-15 when patients complain of symptoms

  • *INCREASE SCr + BUN**
  • Decrease* GFR
18
Q

Prognosis of CKD

A

Dependent on:
CAUSE of kidney Disease
TIME of Diagnosis
DEGREE of Albuminurea
Presense of other comorbid conditions

Earlier seen by nephrologist = BETTER outcomes
GFR < 30 // Albuminuria
Progression / HTN / Hereditary / Kidney Disease

19
Q

Dialysis for CKD

A

When on Dialysis / RRT:
Mortality rate is SIGNIFICANTLY HIGHER than other CKD stages
6-8x higher vs non-ckd patient

Cardiovascular Complications = TOP REASON for increased risk of death

20
Q

G3b CKD

What GFR level?

A

Moderate to SEVERE

30-44
GFR mL/min/1.73m2

21
Q

G4 CKD

What GFR level?

A

SEVERELY Decreased

15-29
GFR mL/min/1.73m2

22
Q

G5 CKD

What GFR level?

A

KIDNEY FAILURE

<15
GFR mL/min/1.73m2

23
Q

G3a CKD

What GFR level?

A

Mild-Moderate decrease

45 - 59
GFR mL/min/1.73m2

PDAT3 (23 decks)

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