Chronic Kidney Disease Flashcards
What are some things that can cause albumin to show up in the urine?
- signficant amount of exercise
- UTI
- febrile illness
- decompensated CHF
- menstruation
- acute severe election in blood glucose
- acute severe elevation in blood pressure
Why do we need to use the albumin/creatinine ratio?
- amount of albumin that is in the yrine relative to the amount of creatinine - they do this because the amount of albumin that is in the urine is dependent on how concentrated the urine is
What should be done in a person that has diabetes, but does not have hypertension and had albumin in the urine?
- we would most likely start them on an ACEI or an ARB to decrease the amount of albumin that is in the urine
- we would want to know the potassium levels first though before we recommend one of these
What does an increase in sCr when starting an ACEI mean?
- that it is working! should see less than a 30% increase in the serum creatinine here
What would the effect be of having someone on both an ACEI and an ARB?
-increased hyperkalemia and kidney injury -do not put the person on these at the same time
What are the 3 things that will slow the progression of diabetic nephropathy?
- control blood glucose
- optimal blood pressure control
- ACEI or ARB
What should be the target bp in a person that has both hypertension and albumin in the urine?
- 130/80- has a significant amount of protein in the urine
What is the normal amount of ACR that will be in a person’s urine?
2 mg/mmol
What is the correction of calcium for albumin?
- for every 10 g/L drop in albumin, your calcium should behave as being 0.2 mmol/L higher. Need to correct your calcium level for the albumin level
What does the calcium have to be under before we can start a patient on calcitriol?
2.6
What other element can cause a deposition in the body when combined with calcium? Why is this bad?
- phosphates
- this is bad because it can cause a calcification of the coronary arteries
- if you have some lipid abnormalities and lipid plaques in the heart then this is really not good
- deposition is bad for the heart, and can also make the skin really itchy
What else happens when phosphates and calcium are allowed to bind together?
- it decreases the amount of available calcium
- parathyroid will release PTH (wants to find some calcium) so it will find the calcium in the bones
- this can cause osteoporosis
What can be done to help prevent the build up of the phosphate-calcium complexes? What we do if they cannot do this?
- can decrease the amount of food in the diet that is high in phosphates
- if a person has to eat food with phosphates in it, get them to take calcium carbonate with the meals (in the stomach the phosphates bind to the calcium and move through the GI tract so that they do not move to the blood)
- the person will just poop out of the calcium and the phosphates bound together
What is the one thing that the person should be aware of when using calcium carbonate to bind phosphates?
-the person can become hypercalcemic
What target should be reaching for for phosphates?
1.8 mmol/L
