#37 - CKD Flashcards
CKD =
chronic kidney disease
Define stage 1 CKD
GFR >90, with kidney damage (eg, proteinuria)
no symptoms
Define stage 2 CKD
GFR 60-89
no symptoms
Define stage 3 CKD
GFR 30-59
Symptoms start!!
Define stage 4 CKD
GFR 15-29
symptoms present.
Define stage 5 CKD
GFR
What is the blood pressure target for ALL patients with CKD?
less than 140/90.
This is the same for diabetics and non-diabetics.
What does hyperphosphatemia do in CKD?
it causes increased CV events/ increased mortality. Probably due to deranged calcium homeostasis/ calcific vessels.
High phosphate also increases PTH.
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?
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.
T/F Mortality from CV disease in CKD patients is 5x the level in non-CKD patients
False. It is 8-10 times higher.
T/F Once CKD is present, the risk for CV is the same no matter the stage.
False. the worse the CKD, the more likely a CV event.
What are the major 4 risk factors for development of CKD?
- diabetes
- hypertension (these 2 account for ~75% of disease)
- family history
- ethnicity
T/F Those over 65 years old are at the greatest risk for CKD.
True. Increasing age = increasing risk of CKD. But it can happen in younger pt’s.
relationship of serum creatinine with GFR.
serum creatinine relates inversely with GFR -
the higher the serum creatinine, the lower the GFR.
T/F Creatinine is an accurate indicator of GFR.
FALSE. It depends on many factores.
Name 5 factors which affect creatinine levels, independent of GFR.
- muscle mass
- age
- diet
- gender
- race
Cockcroft-gault equation
- calculates GFR
- based on age, weight, gender, and serum creatinine
- not used in clinic
- used in pharmaceuticals, for drug dosing.
What equation is used clinically for GFR?
- the epic derivation (automatically calculated)
- it is based on age, woman, black, serum creatinine
limitations of using EPIC’s automatic GFR calculation
it is accurate for GFR
At what stage should treatment for CKD begin?
Stage 1!!!
At what stage do symptoms of CKD start?
Stage 3!!!
evaluation of anemia in CKD
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.
What are the 2 most important things to control to slow progression of CKD?
- blood pressure / hypertension.
- proteinuria (use ACEi’s or ARBs)
7 things which slow progression of renal disease.
- control of BP
- control of proteinuria (ACEi)
- smoking cessation
- glycemic control
- control of anemia
- correction of dyslipidemias
- control of metabolic acidosis.
Treatment for hypertension in CKD patients
-Low salt diet! (
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
Evaluation of proteinuria in CKD patients
- use dipstick
- if dipstick is negative in high risk pt’s (diabetes hypertension), order a urine microalbumin
what is the normal protein/creatinine ratio?
What symptoms are commonly present in stage 3 CKD?
anemia, early bone disease.
What symptoms are commonly present in stage 4 CKD?
-fatigue, swelling, nausea vomiting.
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
diet restrictions in CKD patients- differences b/t CKD and ESRD?
for regular CKD
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.
Why is control of metabolic acidosis important in CKD?
- increases bone resorption
- increases protein degradation,
- increases muscle wasting
Goal of treatment for metabolic acidosis in CKD
treat if bicarb 22.
treatment for metabolic acidosis in CKD
baking soda, or sodium bicarbonate tabs.
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
Treatment of hyperphosphatemia in CKD patients
phosphate binders with meals
Target levels for PTH in CKD patients.
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.
When should referral for kidney translplant be made?
ideally, before dialysis. Results with transplant are much better than dialysis.
