Chronic kidney diseaes Flashcards
serum creatinine influenced by…
sex
age
muscle mass
is 24 hr urine collection vs eGFR
no more accurate
CKD on ultrasound
- small shrunken kidneys 9 vs 10-13 cm
- increased cortical echogenicity
What is the urinalysis like in CKD vs AKI?
Bland urine, with protein
NO ACTIVE SEDIMENT
How do you define CKD, 3 conditions
1- eGFR
which stage/classification of CKD includes an eGFR greater than 60 but with hematuria/proteinuria/anatomic abnormalities
Stage 1 and 2
Stage 3 CKD is now
2 sub classes that include albuminuria
3 most common causes of CKD
- diabetic glomeruloscelrosis
- vascular diseases - HTN/ RAS
- Glomerular diseases (primary or secondary)
what can you use to delay the progression of CKD?
- ACEi or ARB (rein-2 study)
- statins
- BP control
- smoking cessation
- Glycemic control
BP targets without DM vs with DM
- without 140/90
with - 130/80
patients with eGFR
NSAIDs, COXIBs, IV contrast
should refer to a nephrologist when
eGFR
Bone and mineral metabolism complications in patients with CKD
- Hypocalcemia
- Hyperphosphatemia
Electrolyte abnormalities in patients with CKD
Hyperkalemia
Metabolic acidosis
Uremic abnormalities in patients with CKD?
- N/V
- pruritis
- encephalopathy
how does reduced GFR lead to anemia?
- decreased EPO production from peritubular fibroblasts
what happens to PTH levels in CKD?
Elevated with Hyperphosphatemia and low calcium - Secondary hyperparathyroidism
patients with CKD can present how?
- edema
- N/V
- pericarditis
- Met acidosis
- hyperkalemia
what are the goals of dialysis for CKD patients
- Blood purification - solute/toxin removal
- Ultrafiltration - salt and water removal
in peritoneal dialysis how do creatinine and urea get removed (diffusion)
by concentration gradients
what gets removed through an osmotic gradient in peritoneal dialysis?
- Fluid - due to high glucose in dialysate
What is shown to slow the progression to ESRD
ACEi/ARB
