chronic kidney disease Flashcards
what is the distinguishing factor between acute and chronic kidney failure?
- 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
what are the stages of chronic kidney disease?
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
the CKD epi GFR is based on what three factors
Age, Race, creatinine
what is the main thing to decreasing progression of CKD?
-blood pressure control is the main thing to handle
What do you do to decrease progression of CKD?
- BP control
- Ace inhibitors/ARB
- A1C
- statins
- antioxidants
what is the target blood pressure for proteinurics and diabetes? under 60?
the target BP is officially 140/80
how are ACE-I and ARBs helpful? What about used as a combo? side effects?
-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*
how is glycemic control helpful in decreasing the progression of CKD?
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.
what is the major problem in chronic kidney disease patient? what do they end up dying from
cardiovascular disesase and below that is infection
What condition has a high rate in Chronic kidney disease?
obstructive sleep apnea
why is coronary artery disease associated with CKD?
- 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
studies have shown that statins in dialysis patients
does not improve outcomes
what stages of CKDs need to be on statins
CKD 3 and below should be on statins but not CKD4 and 5
what are the four systems that are perturbed in CKD according to this lecture
- Acid-base Balance
- Potassium (hyperkalemia)
- Calcium phosphate-PTH-vitamin D system
- Anemia
what happens with acidosis in CKD?
- 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
how do these patients get acidosis?
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
what is the treatment of acidosis? and what is the target level of bicarbonate
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
what is the hyperkalemia in CKD associated with and what medication must you watch out for
- high rate of Type 4 RTA in CKD
- impedes the use of ACE-I/arbs
what are the treatments for hyperkalemia
- treat with low potassium diet
- or use kayexalate which binds potassium in gut and reduces serum potassium
how is the calcium and phosphate homeostasis disordered in CKD?
- 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
people with elevated phosphorus and calcium-phosphate have increased
morbidity and mortality from increase in arteriolar calcification
what are the treatments for Calcium/phosphate disorder in CKD
- low phosphate diet
- use of phosphate binders such as calcium or non-calcium binders
- 1,25 vitamin D analogues
- calcium sensing receptor modulator
what is the target phosphate level in dialysis patients vs CKD and target calcium
less than 5.5 vs less than 4.5
less than 9.5 in calcium
what are phosphatonins?
clas of phosphate-regulating factors that results in decreased phosphate levels but may lead to increased mortality
