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Unit 7 > chronic kidney disease > Flashcards

chronic kidney disease Flashcards

1
Q

what is the distinguishing factor between acute and chronic kidney failure?

A
  • acute is often oliguric, associated with medicines or illness, have markers that are under investigation
  • chronic is usually non-oliguric or polyuric, sometimes causes small kidneys, hyperparathyroidism and anemia make the chronic kidney more likely
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2
Q

what are the stages of chronic kidney disease?

A

Stage 1: Normal or increased GFR with kidney damage- > or =90
Stage 2: Decreased or mild GFR with kidney damage 60-89
Stage 3: Moderate Decrease in GFR 30-59
Stage 4: Severe decrease in GFR 15-29
Stage 5: Kidney failure less than 15 or dialysis

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3
Q

the CKD epi GFR is based on what three factors

A

Age, Race, creatinine

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4
Q

what is the main thing to decreasing progression of CKD?

A

-blood pressure control is the main thing to handle

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5
Q

What do you do to decrease progression of CKD?

A
  • BP control
  • Ace inhibitors/ARB
  • A1C
  • statins
  • antioxidants
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6
Q

what is the target blood pressure for proteinurics and diabetes? under 60?

A

the target BP is officially 140/80

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7
Q

how are ACE-I and ARBs helpful? What about used as a combo? side effects?

A

-they are nephroprotective and anti-proteinuric
however the combination may make outcomes worse
- they cause angioedema and it blocks bradykininase causing difficulty breathing
-hyperkalemia from blocking RAAS system
-Moderate fall in GFR (actually a prime drug effect)
-patients with renal artery stenosis*

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8
Q

how is glycemic control helpful in decreasing the progression of CKD?

A

glycemic control reduces the rate of development of microalbuminuria and albuminuria in diabetic patients with nephropathy

  • however standard therapy is better than intensive for glucose control
  • older, sicker patients are more likely to die from intensive treatment
  • hypoglycemia can result in hospitalization or worse outcomes.
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9
Q

what is the major problem in chronic kidney disease patient? what do they end up dying from

A

cardiovascular disesase and below that is infection

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10
Q

What condition has a high rate in Chronic kidney disease?

A

obstructive sleep apnea

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11
Q

why is coronary artery disease associated with CKD?

A
  • uremia is atherogenic and accelerates atherosclerosis
  • dialysis is atherogenic because there is an oxidative surge from exposing blood to foreign membrane
  • calcium-phosphate overload worsens coronary artery disease–> forms plaques and stones
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12
Q

studies have shown that statins in dialysis patients

A

does not improve outcomes

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13
Q

what stages of CKDs need to be on statins

A

CKD 3 and below should be on statins but not CKD4 and 5

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14
Q

what are the four systems that are perturbed in CKD according to this lecture

A
  • Acid-base Balance
  • Potassium (hyperkalemia)
  • Calcium phosphate-PTH-vitamin D system
  • Anemia
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15
Q

what happens with acidosis in CKD?

A
  • increased degradation of muscle protein
  • dissolution of bone as calcium carbonate is pulled out of bone–> long term acidosis affects your bones
  • decreased albumin synthesis
  • stimulation of inflammation
  • decreased insulin responsiveness
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16
Q

how do these patients get acidosis?

A

Type 1 RTA(hypokalemia) and type 4 Renal tubular acidosis (hyperkalemia) from loss of nephrons and inability to excrete daily load of acid (not related to GFR)
ultimately buffered by bone

17
Q

what is the treatment of acidosis? and what is the target level of bicarbonate

A

with bicarbonate or equivalent, with sodium or potassium(not too much or you will get hypertension) …target serum bicarbonate is above 20 with renal benefits shown

18
Q

what is the hyperkalemia in CKD associated with and what medication must you watch out for

A
  • high rate of Type 4 RTA in CKD

- impedes the use of ACE-I/arbs

19
Q

what are the treatments for hyperkalemia

A
  • treat with low potassium diet

- or use kayexalate which binds potassium in gut and reduces serum potassium

20
Q

how is the calcium and phosphate homeostasis disordered in CKD?

A
  • the patient can get hyperparathyroidism from elevated PTH due to decrease in calcium serum levels and decreased phosphate excretion.
  • decreased 1,25 -Vit decreases calcium and increases PTH
21
Q

people with elevated phosphorus and calcium-phosphate have increased

A

morbidity and mortality from increase in arteriolar calcification

22
Q

what are the treatments for Calcium/phosphate disorder in CKD

A
  • low phosphate diet
  • use of phosphate binders such as calcium or non-calcium binders
  • 1,25 vitamin D analogues
  • calcium sensing receptor modulator
23
Q

what is the target phosphate level in dialysis patients vs CKD and target calcium

A

less than 5.5 vs less than 4.5

less than 9.5 in calcium

24
Q

what are phosphatonins?

A

clas of phosphate-regulating factors that results in decreased phosphate levels but may lead to increased mortality

25
Q

why is anemia common in CKD patients

A

-absolute and functional deficiency is common
- with inflammation, hepsiden is increased and iron gets trapped in stores and decreases feroportin(stays in enterocytes) can’t absorb it
-functional can’t access the stored onces
anemia causes CHF

26
Q

treatment of anemia is ?

A

treat it so you have less symptoms and prevent blood transfusions

27
Q

what are the three types of accesses for hemodialysis? a

A
  • tunneled catheter
  • AV graft
  • AV fistula
28
Q

what do you have to consider with AV fistula in order to get the best outcomes?

A

AV fistula has the best outcomes but it takes 1-3 months to put in, prepare, and mature, requires planning

29
Q

how is nutrition affected in CKD patients

A

patients

30
Q

patients initiating renal replacement therapy do worse with

A

low albumins

31
Q

patients with dropping albumins might be

A

a sign that they need the dialysis sooner than later

dropping albumin means increase in uremia

32
Q

uremia causes what that can worsen nutrition

A

causes decreased appetite

33
Q

what are the clinical signs of uremia? and what treatment to they point to

A
  • poor appetite, falling albumin or weight; they generally feel ill
  • they point to dialysis/ renal replacement
34
Q

what are the criteria for initiation of renal replacement

A

uremia, intractable volume overload, rarely for acidosis or hyperkalemia

35
Q

what can you control in hemodialysis?

A
  • the amount of clearance
  • the volume change
  • the amount of calcium and potassium
36
Q

in hemodialysis what do you have to not forget about diet

A

low K, low Na, Low phos

37
Q

what is peritoneal dialysis and main complications?

A

peritoneal membrane is used as dialysis membrane.

small chance of peritonitis but don’t have to worry about foreign problems when encountering blood

38
Q

what are the different types of transplant?

A
  • cadaveric transplantation
  • must have a ABO match but HLA antigens not as big of a deal
  • brain death vs cardiac death donors
  • living vs unrelated
  • combined organ transplant
39
Q

what is the down side with transplantation?

A

immunosuppressive drugs
increased infections
drug interactions
tolerance with lower doses

Unit 7 (13 decks)

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