Chronic Kidney Disease

Question 1

What is the difference between chronic kidney disease and acute kidney disease?

Answer 1

Acute kidney disease happens very fast and normally if you treat the underlying problem it goes back to normal.
Whereas chronic kidney disease happens over someone’s lifetime

Question 2

What is End Stage Renal Disease and what laboratory values indicate it?

Answer 2

The stage where kidneys cannot sustain life

This is indicated by a SCr of 10 and a BUn of 100

Question 3

What are the two national guidelines for kidney disease?

Answer 3

KDOQI + KDIGO

Question 4

How often/how long does dialysis happen?

Answer 4

Dialysis happens 3 days a week for 4 hours

Question 5

What are the major causes of CKD?

Answer 5

-Diabetes mellitus
-Hypertension
-Glomerulonephritis
-Polycystic Kidney Disease (PKD) *common in young people
-Nephropathy

Question 6

How is CKD defined by KDIGO?

Answer 6

Abnormalities of kidney structure, present for >3months with implications for health

Question 7

How is CKD classified?

Answer 7

Based on cause, GFR, and albuminuria category

Question 8

What is uremia?

Answer 8

A cluster of symptoms associated with End Stage renal Disease. Symptoms are typically due to accumulation of waste molecules in the blood that are normally removed by the kidneys

Question 9

Which lab value is monitored for signs of uremia?

Answer 9

BUN (blood urea nitrogen)

Question 10

What are the functions of the kidney?

Answer 10

1. Excrete waste products of metabolism from the blood
2. Regulates the body’s concentration of water and salt
3. Maintains acid balance of plasma
4. Synthesizes calcitriol
5. Secretes hormones

Question 11

Will diuretics work in patients with kidney disease?

Answer 11

Will not work in patients with no functioning kidney!!!!

-Can be used in stage 3 and 4

Question 12

What considerations should be addressed when using diuretics with kidney disease?

Answer 12

1. Thiazides are ineffective when CrCl< 30ml/min
2. Loops will work when CrCl<30ml/min
3. Furosemide bioavailability is about 50% (oral dose may be twice the IV dose)
4. Avoid potassium-sparing diuretics!
5. As renal function declines and loop diuretics reach max dose, thiazides may be added to overcome diuretic resistance

Question 13

What is the one loop diuretic that is not a sulfa-type drug?

Answer 13

Ethacrynic acid

Question 14

What should the daily sodium intake be for a patient with high sodium levels?

Answer 14

<2g sodium/ day
OR
<5g NaCl /day

Question 15

What should the daily potassium intake be for a patient with high potassium levels?

Answer 15

3 gm/day

Question 16

Which of the following diuretics is least likely to cause an allergic sulfa reaction?

A. furosemide
B. ethacrynic acid
C. torsemide
D. bumetanide

Answer 16

B. ethacrynic acid

Question 17

What are the 3 things that affect the parathyroid gland and how do they affect it?

Answer 17

High phosphorus
Low calcium
Low Vitamin D

*All three of these increase PTH release
*Phosphorus has the greatest impact

Question 18

When should dietary phosphorus intake be restricted to 800-1000 mg/day?

Answer 18

1) Phos >4.6 mg/dL (stage 3 and 4)
2) Phos > 5.5 mg/dL (stage 5)
3) PTH > Target range for stage 3, 4, or 5

Question 19

What is the role of erythropoietin (EPO)?

Answer 19

Promotes production of mature red blood cells in the bone marrow

-Having more red blood cells in the circulation leads to increased oxygenation and lower levels of hypoxia-inducible factor which suppresses EPO production

*EPO is made by the kidneys

Question 20

What are the monitoring parameters for anemia?

Answer 20

Hb (hemoglobin)
MCV (mean corpuscular volume)
RDW (red cell distribution width)
TSAT
Ferritin

Question 21

What are the 4 mechanisms by which ESRD patients will develop anemia?

Answer 21

1) Decreased production of erythropoietin ***(main)
2) Uremia causes a decreased life span of red blood cells
3) Vitamin losses during dialysis
4) Dialysis (loss of blood through dialyzer (hemolysis))

Question 22

What are the symptoms of anemia?

Answer 22

Headache
Palor
Decreased cognition
Fatigue

Question 23

What is microcytic anemia?

Answer 23

Blood cells are small
(Low MCV)

Question 24

What is macrocytic anemia?

Answer 24

Blood cells are large
(High MCV)

Question 25

What is normocytic anemia?

Answer 25

The blood cells are a normal size, but there is less of them than normal

Question 26

What is the best assessment parameter for anemia?

Answer 26

Hb is the best assessment parameter because it has increased stability over Hct (hematocrit)

Question 27

What is the relationship between transferrin and ferritin?

Answer 27

Transferrin is the delivery truck and ferritin is the stored iron (warehouse)