Chronic Kidney Disease Flashcards
criteria for different stages of CKD
according to GFR Stage 1: >89 w/ hematuria or proteinuria Stage 2: GFR 60-89 Stage 3: GFR 30-59 Stage 4: GFR 15-29 Stage 5: GFR <15 or on dialysis
renoprotective factors
tight glucose control
tight BP control (BP<130/80)
reduction of proteinuria (w/ ACEI/ARB)
others: smoking cessation, statin therapy, anemia management
complications of CKD
anemia hyperkalemia hyperphosphatemia secondary hyperparathyroidism metabolic acidosis HTN uremia
indications for dialysis
refractory acidosis, hyperkalemia or fluid overload
Uremia (esp encephalopathy, uremic pericarditis)
malnutrition
which renal hormones decrease in CKD
calcitriol
EPO
criteria for CKD
GFR 6 months
CKD staging
CGA
cause
GFR category
Albuminuria category
major cause of death in CKD
CVD
why does CKD lead to HTN?
volume expansion
CKD effect on phosphate and vit D
vit D deficiency
phosphate retenion
PTH actions (4)
- promotes renal synth of calcitriol –> enhances calcium and phosphate absorption in the gut
- increases calcium reabsorption in DT
- decreases proximal phosphate reabsorption (by decreasing activity of Na-Phosphate transporter)
- stimulates bone resorption if there is enough calcitriol
how does CKD cause secondary hyperparathyroidism?
GFR drops –> decrease in serum Ca2+ –> stimulates PTH, which brings calcium back up to normal
process continues to balance electrolytes at the expense of rising PTH
at stage 4, serum phosphorous increases b/c aren’t enough functioning nephrons to get rid of phosphate despite rising PTH
FGF23
responds to increase in phosphorus –> decrease phosphate reabsorption + INHIBITS 1alpha-hydroxylase