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SU18: Internal med final > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

chronic kidney disease

A

progressive loss of renal fxn persisting >3 months

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2
Q

causes of chronic kidney disease

A
  • diabetes
  • hypertension
  • chronic glomerulonephritis
  • polycystic kidney disease
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3
Q

what percent of chronic kidney disease is caused by diabetes?

A

37%

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4
Q

what percent of chronic kidney disease is caused by hypertension?

A

24%

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5
Q

pathophysiology of chronic kidney disease

A
  • progressive destruction/deterioration of nephrons

- hypertrophy of remaining nephrons to compensate

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6
Q

homeostasis is preserved until what percent of nephron destruction?

A

> 50%

*can go without symptoms until then

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7
Q

what is used to diagnose and monitor chronic kidney disease

A

glomerular filtration rate (GFR)

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8
Q

glomerular filtration

A

process by which kidneys filter blood to remove excess waste and fluid

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9
Q

glomerular filtration rate (GFR)

A

a calculation to determine how well the blood is filtered by the kidneys

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10
Q

what is the best measure of overall fxn of kidneys?

A

GFR

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11
Q

clinical presentation of early disease

A

asymptomatic

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12
Q

what leads to symptoms of chronic kidney disease?

A
  • nitrogenous waste builds up in blood

- kidneys perform fewer excretory, endocrine, and metabolic fxns

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13
Q

how many chronic kidney disease stages are there?

A

5

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14
Q

stage 1 of chronic kidney disease

A

normal kidney fxn

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15
Q

what percent of kidney fxn do pts in stage 1 have?

A

90-100%

*pts at high risk of developing chronic kidney disease and need testing

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16
Q

stage 2 chronic kidney disease

A

mild kidney fxn

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17
Q

what percent of kidney fxn do pts in stage 2 have?

A

60-89%

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18
Q

at what stage of CKD are pts symptomatic?

A

stage 3

19
Q

stage 3 chronic kidney disease

A

moderate kidney fxn

20
Q

what percent of kidney fxn do pts in stage 3 have?

A

30-59%

21
Q

stage 4 chronic kidney disease

A

severe kidney fxn

22
Q

what percent of kidney fxn do pts in stage 4 have?

A

15-29%

23
Q

stage 5 chronic kidney disease

A

kidney failure

24
Q

what percent of kidney fxn do pts in stage 5 have?

A

0-14%

25
Q

medical management of CKD pts

A
  • conservative care
  • dialysis
  • kidney transplant
26
Q

conservative care is a way to medically manage pts in which stage of CKD?

A

stages 1 & 2 (GFR>60)

27
Q

what does conservative care consist of?

A
  • decrease nitrogenous waste retention (modified diet to decrease protein intake)
  • control HTN, fluids, electrolyte imbalance by limiting fluid, sodium, potassium intake
  • correct/control diabetes, HTN, chronic HF, hyperparathyroidism
28
Q

dialysis is for pts in what stage?

A

stage 5 but sometimes 4

*GFR <30 decision made on case by case basis

29
Q

dialysis

A

artificial blood filtration

30
Q

pts with what GFR must be under dialysis?

A

<15%

31
Q

percent of pts that do peritoneal dialysis (dialysis at home)

A

20%

32
Q

what is the decision to start hemodialysis?

A

GFR + clinical presentation

33
Q

how often is hemodialysis?

A

every 2-3 days, 3-4 hours per session

34
Q

are pts sick in between sessions of dialysis?

A

no, pts live a normal life relatively

35
Q

what percent of normal renal fxn does hemodialysis provide?

A

only 15%

36
Q

what is the best day to txt pts for dental care?

A

day after dialysis

37
Q

what is surgically created in the forearm of dialysis pts?

A

AV fistula/graft

38
Q

what does the AV fistula/graft allow?

A
  • good access

- good blood flow

39
Q

can we use the AV fistula/graft to check BP?

A

NO, only for urologist to use

40
Q

dental management of CKD pts that are conservatively managed

A
  • no contraindications to routine dental care but consult physician
  • avoid/adjust dosage of nephrotoxic drugs and those excreted by kidneys if GFR <60
41
Q

what are common dental drugs CKD pts should avoid?

A
  • NSAIDS

- Tylenol

42
Q

why is Tylenol nephrotoxic when the liver metabolizes it?

A

because kidney excretes it

43
Q

dental management of CKD pts on hemodialysis

A
  • physician consultation
  • dental txtment on day after dialysis
  • avoid nephrotoxic drugs and those metabolized by kidney
  • no BP cuff on AV shunt
44
Q

is antibiotic prophylaxis indicated for CKD pts on hemodialysis?

A

no, will get out of system at next dialysis session

SU18: Internal med final (25 decks)

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