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NEPHRO & GENITOURINARY > CHRONIC KIDNEY DISEASE > Flashcards

CHRONIC KIDNEY DISEASE Flashcards

1
Q

3 Definitions

A

eGFR <60 for >/3 mo
OR
Kidney Damage >/3 mo: persistent proteinuria (significant + dip 2/3 OR +ACR done 2-8w apart)
OR
abnormal urinary sediment
OR
abnormal imaging

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2
Q

5 Symptoms

A

Fatigue
Anorexia
Nausea / Vomiting
Edema
Oliguria
Anemia
Pruritis

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3
Q

5 Risk Factors

A

Age
BMI
DM
HTN
Vascular disease
Glomerular disease (autoimmune, malignant, systemic infection, renally excreted drugs, neoplasia)
Tubulointerstitial disease (UTI, stones, obstruction, drug toxicity) PCKD
Smoking

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4
Q

5 Factors that affect GFR

A

Extreme Weights
Muscle Mass
Amputation
Paralysis
Specific Diets (high / low protein)
Meds that affect Cr excretion
Illness
Pregnancy

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5
Q

Who do you screen and how often? Is age alone a reason to screen?

A

Q 1 -2 years (q yearly for DM)
Age > 18 AND First Nations, Inuit, Metis
HTN
DM
Age 60-75 w/ CVD
Age alone is NOT a reason to screen

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6
Q

Diagnostic criteria? How often do you repeat the test?

A

eGFR: <60 then repeat in 3 mo or sooner if rapid decline
Adjust for black patients by x 1.21
Urine Albumin-creatinine Ratio: >/3 repeat 1-2x over next 3 mo

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7
Q

List 5 DDx / Reversible causes

A

Acute Illness
Dehydration
AKI
NSAIDS
BPH / Retention

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8
Q

After diagnosis, how often / what do you check for disease progression?

A

Measure Cr 2x, 2-6 weeks apart

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9
Q

5 complications / co morbidities

A

AKI
anemia
HTN
LVH
CHF / Volume Overload
Hypocalcemia
Hyperkalemia
Hyperparathyroid
Hyperphosphatemia
Metabolic Acidosis
Malnutrition
Drug Toxicity

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10
Q

List 5 additional measurements and labs do you order after diagnosis?

A
  1. BP (cause)
  2. BW
    FBG (cause)
    Cr, BUN
    Extended Lytes (Ca, Pho, Mg) (complication)
    CBC, Ferritin, TIBC (complication)
    Serum protein electrophoresis + Bence jones proteins
  3. Urinalysis:
    Hematuria + proteinuria (glomerular)
    Proteinuria (>+1 protein) -> investigate further with albumin / cr ratio of 1st am void (2/3 ACR >/3mg/mmol within 3 mo confirms CKD)
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11
Q

What imaging would you consider? Why?

A

Kidney Ultrasound: r/o hydronephrosis, stones, cysts

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12
Q

5 Lifestyle Interventions

A

Smoking cessation
Healthy weight (nutrition, exercise)
Diet modification if eGFR<60 (not on dialysis)
Limit sodium (<2g/day or <5g salt/day), protein (0.8g/kg/day), phosphate (0.8g/day), calcium (1.5g/d), potassium (1.5g/d)
Moderate alcohol consumption

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13
Q

Preferred medication for CKD + HTN

A

Acei / ARB

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14
Q

Steps to treat and monitor if CKD stage 3 + proteinuria. What is an acceptable increase in Cr, lytes? What is an acceptable K+ level? What are indications to stop the drug?

A

ACEi / ARB controversial
Consult nephrology
Monitor Cr, BUN, lytes weekly until baseline
An increase fo 20 - 30 % is acceptable
K+ of 5.5 is acceptable if stable
If K+ > 5.5 or Cr > 30% baseline stop drug

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15
Q

When do you NOT use an ACEi / ARB in CKD?

A

With no proteinuria

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16
Q

What are target BP for HTN in CKD

A

<120 SBP

17
Q

Is a statin indicated in CKD?

A

Yes, it is a statin indicated condition

18
Q

What is the DM target?

A

A1c < 7%

19
Q

How often is Cr, ACR, K monitored?

A

Measure Cr at least q 6 mo
ACR q6-12 mo
Measure K w/ med / clinical change (target < 5.5)

20
Q

What must be monitored annually when eGFR < 30

A

annual CBC, iron, Ca, Pho, Albumin

21
Q

What further steps must be taken to minimize further renal injury?

A

Renally Dose Medications
Avoid NSAIDs, Aminoglycosides, Lithium, contrast media

22
Q

List 5 Sick Day Medications list (to avoid if unable to maintain hydration)

A

SADMANS:
Sulfonylureas, ACEI, Diuretics, Metformin, ARB, NSAIDs, SGLT2i

23
Q

What vaccinations are recommended?

A

Pneumococcal vaccine q 5 yr
Flu vaccine q yearly

24
Q

RIFLE criteria

A

Risk
Injury
Failure
Loss
End-Stage Renal Disease

25
Q

Discribe Risk Category with GRF and Urine Output Criteria

A

GFR decrease 25-50%
Urine Output 0.5 ml/kg/h for 6h

26
Q

Discribe Injury Category with GRF and Urine Output Criteria

A

GFR decrease 50-75%
Urine Output 0.5 ml/kg/h for 12

27
Q

Describe Failure Category with GRF and Urine Output Criteria

A

GFR decrease >75%
Urine Output 0.3 ml/kg/h for 24h OR anuria for 12 h

28
Q

Discribe Loss with Category GRF and Urine Output Criteria

A

Complete loss of kidney function for > 4 wk

29
Q

Discribe End Stage Renal Disease with Category GRF and Urine Output Criteria

A

Need for renal replacement therapy for > 3 months

NEPHRO & GENITOURINARY (10 decks)

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