Chronic Kidney Disease Flashcards
What is the prevalence of CKD and why? What are long term adverse outcomes and associated risks? Why is early detection important?
Increasing incidence due to aging population and increased prevalence of DM and HTN
Long term adverse outcomes from CKD include impaired kidney function, end stage renal failure, and death
Associated with significantly increased risk of CV disease and stroke
Patients and providers need heightened awareness of CKD
Early detection and management of CKD can often delay progression
What is the function of the kidney?
Regulate water Balance salts- sodium and potassium Acid Base Balance Calcium Reabsorption/Vitamin D activation Blood Pressure Red Blood Cell Production Filter waste/excretes medication
What are normal age-related changes to kidney?
Kidney function slowly declines as we get older and that is a natural process
That process happens a bit more rapidly after age 45
What are potential causes/contributors to kidney injury?
Infection (post – strep glomerulonephritis) Autoimmune process (Lupus nephritis) Medications Volume depletion-N/V, diuretic use Obstruction
How does the kidney respond to injury?
Increased filtration in the remaining normal nephrons- adaptive hyper-filtration
Additional homeostatic mechanisms permit the serum concentrations of sodium, potassium, phosphorus, calcium and the total body water to remain within normal range, particularly among those with mild-moderate renal failure.
What is Adaptive Hyper-filtration?
Initially beneficial
Often results in long term damage to glomeruli of remaining nephrons
Manifested by proteinuria and an increase in circulating biomarkers of kidney disease (BUN/Creatinine) and progressive renal failure
Define CKD
CKD is defined by the presence of structural or functional abnormalities of the kidney for three or more months, irrespective of the cause
The persistence of the kidney damage or decreased kidney function is necessary to distinguish it from Acute Kidney Injury (AKI). In AKI an appropriate evaluation for reversible causes should be performed
National Kidney Foundation – CKD is a decline in glomerular filtration rate (GFR) to <60mL/min/1.73m2 present for > 3 months
To have a diagnosis of CKD, you must have one or more of the following findings:
Pathologic abnormalities
Markers of kidney damage (imaging abnormalities or serum/urine abnormalities)
GFR less than 60mL per minute per 1.73 m2
What are conditions are risk factors for CKD?
Diabetes Hypertension CVD Hyperlipidemia Obesity Metabolic Syndrome Smoking HIV infection Hepatitis C infection Malignancy Family history of kidney disease Sickle Cell Trait Urinary Outflow Obstruction History of Acute Kidney Injury Persistent Hematuria Treatment with potentially nephrotoxic drugs (NSAID)
What patients are at risk for CKD?
Family history of CKD,DM,HTN African Americans Hispanics American Indians Asians Pacific Islanders >60 years old Recurrent stone disease Frequent UTI Inflammatory disease- RA, SLE
Discuss relationship between DM and CKD
90% are DM Type 2
33% of adult CKD
Initial presentation of diabetic kidney disease is microalbuminuria
30% of DM patients will develop diabetic nephropathy
Discuss relationship between HTN and CKD
80% of CKD patients have HTN
Nephrosclerosis occurs from long periods of uncontrolled HTN contributing to end organ damage
What are the most common causes of CKD?
- HTN
- DM
What screening does the National Kidney Foundation recommend?
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) recommends that all individuals should be assessed as part of a routine health examination to see if they have increased risk for developing chronic kidney disease.
What are methods of screening for CKD?
Urine test for proteinuria- spot urine in am /measure urinary albumin to creatinine ratio
Blood test for creatinine (a bi-product of muscle metabolism circulating in blood) and GFR
Blood pressure monitoring-goal is <130/80
