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Steph ASN BRCU Review > ASN QBank Pearls - CKD and ESRD > Flashcards

ASN QBank Pearls - CKD and ESRD Flashcards

1
Q

combination of a diameter > 4 mm AND access flow > 500 mL/min predicts what success rate of use of fistula for HD?

A

95%

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2
Q

combination of fistula diameter < 4 mm AND access flow < 500 mL/min predicts what success rate of use of fistula for HD?

A

33%

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3
Q

treatment of dialysis catheter-related bacteremia with an antibiotic lock is most successful with what type of infections and what success rate?

A

gram-negative, about 90%

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4
Q

treatment of dialysis catheter-related infection with Staph epidermidis bacteremia with an antibiotic lock has what success rate?

A

about 75%

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5
Q

treatment of dialysis catheter-related infection with Staph aureus bacteremia with an antibiotic lock has what success rate?

A

about 40%

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6
Q

randomized, controlled trial, that showed giving CKD and ESRD patients LDL-lowering therapy with simvastatin and ezetimibe had a significant 17% reduction in major atherosclerotic events over 5 years of study

A

SHARP (Study of Heart and Renal Protection) trial

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7
Q
  • does alkali therapy slow progression of CKD?

- how?

A
  • yes!
  • reduces tubulointerstitial damage by limiting inflammatory urinary biomarkers such as endothelin (ET) and transforming growth factor (TGF)-β
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8
Q

the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial indicated intensive glycemic control of T2DM does not decrease incidence of

A

nephropathy and cardiovascular 
mortality

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9
Q

the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial indicated intensive BP control in T2DM was associated with

A

greater progression of nephropathy

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10
Q

patients with this condition have normalization of BP and serum K+ during pregnancy

A

primary hyperaldosteronism

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11
Q

why do patients with primary hyperaldosteronism have normalization of BP and serum K+ during pregnancy?

A

increase in progesterone levels antagonizes effects of aldosterone

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12
Q

progression of kidney disease strongly relates to the presence of two risk variants in

A

APOL1 with AR pattern of inheritance

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13
Q

diabetes medication associated with increased renal salt retention and the development of edema

A

rosiglitazone

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14
Q

cephalosporin drug accumulation does not usually occur until GFR is

A

< 30 ml/min/1.73 m2

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15
Q

cephalosporin dosing in CKD patients

A

regular loading dose then 75% of usual maintenance dose at regular intervals

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16
Q

antibiotic dosing in CKD patient with acute pyelonephritis

A

regular dosing and intervals (difficult to treat)

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17
Q

progression from CKD stage 3-4 to ESRD in ADPKD can be favorably influenced by?

A

nothing

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18
Q

resistant upper urinary tract infections in patients with PKD and CKD stage V are BEST managed by?

A

fluoroquinolones

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19
Q

what is the incidence of cerebral aneurysms in patients with ADPKD within a family cluster?

A

20%

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20
Q

in all patients with PKD, the incidence of cerebral aneurysms is close to

A

2-5%

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21
Q

cerebral aneurysms should monitored if what size?

A

5 to 10 mm

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22
Q

what size cerebral aneurysm is at higher risk of rupture?

A

> 10 mm

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23
Q

in patients with the phenotype of ADPKD, what is the second most common complication?

A

polycystic LIVER disease

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24
Q

mitral valve prolapse is present in what percentage of patients with ADPKD?

A

10-15%

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25
Q

renal stones are present in what percentage of patients with ADPKD?

A

20%

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26
Q

MOST effective initial approach to increase small solute clearance in PD

A

add a DAY exchange

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27
Q

how many minutes in a day?

A

1440

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28
Q

how many minutes in a week?

A

10,080

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29
Q

BEST approach to management of PD patient at time of hernia repair

A

supine, low-volume exchanges x 4–6 weeks

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30
Q

treatment of hemoperitoneum in young, menstruating women if fluid fails to clear after in-and-out exchanges

A

add HEPARIN to dialysate to prevent blood from clotting

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31
Q

empiric therapy for PD-related peritonitis initially requires adequate coverage for

A

both gram-positive organisms and for gram-negative organisms

32
Q

has been demonstrated to be consistently effective in reducing risk of PD-related peritonitis

A

daily application of antibiotic cream at PD catheter exit site

33
Q

management of high interdialytic weight gain and high BP

A

limit Na+ intake (< 2 g/day) and lower dialysate Na+

34
Q

Gibbs-Donnan effect predicts that

A

isonatric dialysis will only occur if the dialysate Na+ is set < the 
patient’s plasma Na+ activity

35
Q

most of the Na+ flux during hemodialysis is due to

A

convection

36
Q

increase in BP during HD (intradialytic HTN) is an independent risk factor for

A

increased hospitalizations and death

37
Q

LEAST effective method to manage hypotension during hemodialysis

A

sequential UF (isolated UF followed by HD)

38
Q

daily HD has been shown to

A
  • reduce systolic BP
  • reduce left ventricular mass
  • reduce death
39
Q

dry weight reduction intervention (DRIP) trial

A
  • challenge dry weight by 0.1/kg per treatment

- resulted in 7 mmHg lower ambulatory BP at 8 weeks compared with usual care

40
Q

have normalizing Hb with ESAs, lowering LDL with a statin, lowering BP, or preventing intradialytic hypotension been demonstrated in RCTs in HD patients to improve survival?

41
Q

what laboratory variable is the MOST closely associated with an increased probability of death in ESRD patients?

A

low albumin

42
Q

depression is associated with what in ESRD patients?

A

increased mortality

43
Q

which therapies have been shown to improve restless leg syndrome symptoms in HD patients?

A

iron therapy, short daily dialysis, and kidney transplantation

44
Q

which therapy has NOT been shown to improve restless leg syndrome symptoms in HD patients?

A

erythropoiesis-stimulating agents (ESAs)

45
Q

what can cause dementia, osteomalacia, and anemia in ESRD patients?

A

aluminum toxicity

46
Q

medication associated with mental status changes when dosed excessively in a patient with CKD or AKI

A

ranitidine

47
Q

medication associated with neurotoxicity when not dosed appropriately for reduced GFR

48
Q

a/w severe hemolytic anemia in ESRD patients being treated for AMR

A

high-dose IVIG

49
Q

dioxin toxicity in a patient with underlying kidney disease and hyperkalemia is best treated with

A

digoxin-specific Fab fragments

50
Q

potential complication of high flux dialyzer membranes compared with low flux membranes

A

increased exposure to bacterial endotoxin

51
Q

AC that does NOT require dose adjustment in ESRD patients

A

argatroban

52
Q

an increase in which of the following is MOST likely to cause an ESA-hyporesponsive anemia by reducing iron availability for erythropoiesis in CKD and ESRD patients?

53
Q
  • renal infection; granulomatous inflammatory disease
  • MRI; poorly defined multiple low signal intensity nodules on all sequences with intervening fibrous stroma
  • renal histopathology; foam cells with Michelis-Guttman bodies
A

renal malacoplakia

54
Q

hallmark feature on skin biopsy for calcific uremic arteriolopathy (calciphylaxis)

A

septal panniculitis

55
Q

water treatment

- removes chlorine and chloramines

A

carbon tank

56
Q

water treatment

- removes excess Ca++ and Mg++

A

water softener

57
Q

water treatment

- removes almost everything including viruses and bacteria

A

reverse osmosis system

58
Q

water treatment

- quality of dialysis water is guided by what standards?

A

AAMI (Association for the Advancement of Medical Instrumentation)

59
Q

if chlorine is found in dialysis water what is the next step for the water treatment system?

A

rebed the carbon tanks

60
Q

acute hemolysis in a patient on HD can occur d/t?

A
  • overheating of water
  • hypotonicity d/t insufficient concentrate-to-water ratio
  • contamination w/ formaldehyde, bleach, chloramines, or nitrates
  • copper from tubing or piping
61
Q

MCC of acute hemolysis in a patient on HD

A

chloramine

62
Q

exposure of HD patients to chlorine and chloramines is a/w

A
  • acute hemolysis
  • hemolytic anemia
  • methemoglobinemia
  • ESA resistance
63
Q

exposure of HD patients to chlorine and chloramines is a/w

A
  • acute hemolysis
  • methemoglobinemia
  • ESA resistance
64
Q

water treatment

- removes bacteria and endotoxins

A

submicron filters

65
Q

water treatment

- % rejection formula

A

[(feed water TDS - permeate water TDS)/feed water TDS] x 100

  • TDS = total dissolved solids
66
Q

types of peritonitis in PD patients

- occurs w/i 4 weeks of completing abx, but DIFFERENT organism

A

RECURRENT peritonitis

67
Q

types of peritonitis in PD patients

- occurs w/i 4 weeks of completing abx with SAME organism

A

RELAPSING peritonitis

68
Q

types of peritonitis in PD patients

- lasts > 4 weeks with SAME organism

A

REPEAT peritonitis

69
Q

types of peritonitis in PD patients

- failure of effluent to clear after 5 days of appropriate abx

A

REFRACTORY peritonitis

70
Q

types of peritonitis in PD patients

- peritonitis in conjunction w/ an ESI or tunnel infection with SAME organism

A

CATHETER RELATED peritonitis

71
Q

if CATHETER RELATED peritonitis is d/t Staph aureus or Pseudomonas aeruginosa, what else needs to be done in addition to abx?

A

PD catheter replacement (?needs to be after abx course finished)

72
Q

water treatment

- SOFTENERS should be monitored how often and how?

A
  • DAILY

- by measuring hardness of effluent water

73
Q

water treatment

- CARBON FILTERS should be monitored how often and how?

A
  • DAILY

- check chloramine level

74
Q

water treatment

- RO SYSTEM AND DEIONIZER should be monitored how often and how?

A
  • DAILY

- by measuring RESISTIVITY of effluent water

75
Q

water treatment

- BACTERIOLOGICAL SURVEILLANCE should be monitored how often?

A
  • WEEKLY during VALIDATION phase

- MONTHLY during SURVEILLANCE period

76
Q

water treatment

- complete DISINFECTION of the water treatment plant should be done how often?

A

AT LEAST MONTHLY

Steph ASN BRCU Review (11 decks)

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