#37 - CKD Flashcards

1
Q

CKD =

A

chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define stage 1 CKD

A

GFR >90, with kidney damage (eg, proteinuria)

no symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define stage 2 CKD

A

GFR 60-89

no symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define stage 3 CKD

A

GFR 30-59

Symptoms start!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define stage 4 CKD

A

GFR 15-29

symptoms present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define stage 5 CKD

A

GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the blood pressure target for ALL patients with CKD?

A

less than 140/90.

This is the same for diabetics and non-diabetics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does hyperphosphatemia do in CKD?

A

it causes increased CV events/ increased mortality. Probably due to deranged calcium homeostasis/ calcific vessels.
High phosphate also increases PTH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patient comes in for a follow up checkup. His GFR was 55 a month ago (his first abnormal GFR test). Today it is 50. What is his CKD stage?

A

He cannot be staged yet!
Low GFR or proteinuria must be present for 3 months.

-if his GFR stays the same for 2 more months, he would be stage 3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F Mortality from CV disease in CKD patients is 5x the level in non-CKD patients

A

False. It is 8-10 times higher.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F Once CKD is present, the risk for CV is the same no matter the stage.

A

False. the worse the CKD, the more likely a CV event.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the major 4 risk factors for development of CKD?

A
  • diabetes
  • hypertension (these 2 account for ~75% of disease)
  • family history
  • ethnicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F Those over 65 years old are at the greatest risk for CKD.

A

True. Increasing age = increasing risk of CKD. But it can happen in younger pt’s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

relationship of serum creatinine with GFR.

A

serum creatinine relates inversely with GFR -

the higher the serum creatinine, the lower the GFR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F Creatinine is an accurate indicator of GFR.

A

FALSE. It depends on many factores.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name 5 factors which affect creatinine levels, independent of GFR.

A
  • muscle mass
  • age
  • diet
  • gender
  • race
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cockcroft-gault equation

A
  • calculates GFR
  • based on age, weight, gender, and serum creatinine
  • not used in clinic
  • used in pharmaceuticals, for drug dosing.
18
Q

What equation is used clinically for GFR?

A
  • the epic derivation (automatically calculated)

- it is based on age, woman, black, serum creatinine

19
Q

limitations of using EPIC’s automatic GFR calculation

A

it is accurate for GFR

20
Q

At what stage should treatment for CKD begin?

A

Stage 1!!!

21
Q

At what stage do symptoms of CKD start?

A

Stage 3!!!

22
Q

evaluation of anemia in CKD

A

Always rule out other causes, especially in stage 1 or 2, but also in stage 3-5. If other diagnoses are excluded, give synthetic EPO.

23
Q

What are the 2 most important things to control to slow progression of CKD?

A
  • blood pressure / hypertension.

- proteinuria (use ACEi’s or ARBs)

24
Q

7 things which slow progression of renal disease.

A
  • control of BP
  • control of proteinuria (ACEi)
  • smoking cessation
  • glycemic control
  • control of anemia
  • correction of dyslipidemias
  • control of metabolic acidosis.
25
Treatment for hypertension in CKD patients
-Low salt diet! (
26
Treatment of proteinuria in CKD patients.
ACEi's or ARBS. - Note: ACEi reduces GFR, but that is acceptable because it helps protect the GFR from high pressures, which are damaging. also reduces proteinuria
27
Evaluation of proteinuria in CKD patients
- use dipstick | - if dipstick is negative in high risk pt's (diabetes hypertension), order a urine microalbumin
28
what is the normal protein/creatinine ratio?
29
What symptoms are commonly present in stage 3 CKD?
anemia, early bone disease.
30
What symptoms are commonly present in stage 4 CKD?
-fatigue, swelling, nausea vomiting.
31
list the conditions/ complications in CKD which you need to evaluate for.
- bone mineral disorders (high PTH, kidney can't activate Vit D) - hyperkalemia - Cardiovascular disease - anemia
32
diet restrictions in CKD patients- differences b/t CKD and ESRD?
for regular CKD
33
Treatment of hyperkalemia in CKD.
- low K diet!! - control of hyperglycemia (hyperglycemia causes K to come out of the cell into the ECF) - control metabolic acidosis w/ bicarbonate (H+ traded for K+ in acidosis) -if these don't control hyperkalemia, K wasting diuretics or Kayexalate, a K resin, may be used.
34
Why is control of metabolic acidosis important in CKD?
- increases bone resorption - increases protein degradation, - increases muscle wasting
35
Goal of treatment for metabolic acidosis in CKD
treat if bicarb 22.
36
treatment for metabolic acidosis in CKD
baking soda, or sodium bicarbonate tabs.
37
What are the lab manifestations of a bone mineral disorder in a CKD patient?
- low Ca - high PTH - high Phosphate -mainly due to the inability to activate Vit D
38
Treatment of hyperphosphatemia in CKD patients
phosphate binders with meals
39
Target levels for PTH in CKD patients.
40
30-20-10 rule
-at GFR 30, refer to nephrologist -at GFR 20, start looking at access placement for dialysis at GFR 10, start dialysis.
41
When should referral for kidney translplant be made?
ideally, before dialysis. Results with transplant are much better than dialysis.