Chronic kidney disease

Question 1

Your patient has had a decline in GFR for over a year. There is persistent protein in her urine. She has developed htn. Her kidneys appear to be small upon US. What do you suspect?

Answer 1

Chronic kidney disease (CKD)

Question 2

What is the primary cause of CKD?

Answer 2

DM (>70% of all incidences)

Question 3

What do the kidneys do to compensate for CKD?

Answer 3

hypertophy of nephrons and hyperfiltration causes overwork of remaining nephrons. (Causing glomerular sclerosis and interstitial fibrosis)

Question 4

What medication is helpful in reducing hyperfiltration injury and slowing the progression of CKD?

Answer 4

ACEI’s and ARB’s

Question 5

______________is the volume of fluid filtered from the glomerular capillaries into the Bowman’s capsule per unit time. What is the normal value?

Answer 5

GFR. Normal is >60mL/min/body size.

Question 6

What are symptoms of uremia?

Answer 6

htn (low Na secretion), n/v, fatigue, iritability, mentation, insomnia, RLS, paresthesia, twitching, pruritus, decreased libido

Question 7

Lab values common to CKD

Answer 7

anemia, hyper phosphatemia, hypocalcemia, kyperkalemia, metabolic acidosis, urinary sediment, casts, proteinuria

Question 8

complications of CKD:

Answer 8

htn and CVD, HF from long term increase in cardiac workload, anemia, rarely pericarditis, bone dz (Ca and phosphorus imbalance), acid base disorders, neuro complications(encephalopathy), endocrine (DM)

Question 9

Treatment of CKD:

Answer 9

underlying dz!!! Especially DM, BP control, RAAS control, wt loss, diets (consider protein, salt, fluid, potassium and phosphorus intake), monitor meds for renal interaction, dialysis, transplant

Question 10

Healthy GFR is >60. When should you consider dialysis?

Answer 10

GFR<10

Question 11

In ESRD patients who opt not to utilize dialysis, what is the typical cause of death?

Answer 11

Uremia resulting in encephalopathy, coma, death. OR Electrolyte imbalance resulting in arrhythmia.

Question 12

In the kidneys,____________results from atherosclerotic ischemic dz, htn, AKI from ACEI tx.

Answer 12

Renal artery stenosis (RAS)

Question 13

What can you look for on an imaging test that would indicate RAS?

Answer 13

Asymmetric kidney size (one renal artery affected disproportionately to the other). Can detect with US***, CT, MRA

Question 14

What are treatment options for RAS?

Answer 14

med mgmt, angioplasty, stent, bypass