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BiB Midterm 3 & Final > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Why should we caution against using serum creatinine alone as a measure of kidney function?`

A

Serum creatinine amounts changes depending on the person’s muscle mass (more muscle –> more creatinine). So some people may have more or less than the “normal” range in the clinical setting.

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2
Q

How can we account for difference between people when measuring serum creatinine as a measure of GFR?

A

Put the serum creatinine into 1 of the 3 biometric equations

Cockroft Gault, MDRD, CKD-EPI

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3
Q

What is the official definition of Chronic Kidney Disease?

A

A structural or functional abnormalities for more than 3 months as manifested by either a decrease in GFR OR other kidney damage types

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4
Q

What is the GFR cutoff for diagnosing CKD?

A

GFR <60 ml/min/1.73m2

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5
Q

If you have a kidney transplant does that classify you as having CKD?

A

Yes, if you have a kidney transplant you are considered to have CKD.

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6
Q

Staging of CKD is based solely off of the…?

A

GFR

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7
Q

Describe the GFR at each stage of CKD:

Stages 1-5.

A 
Stage 1: >90
Stage 2: 89-60
Stage 3a: 59-45
Stage 3b: 30-44
Stage 4: 15-29
Stage 5: <15
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8
Q

Explain why CKD stage 1 has a GFR that’s above 60.

A

Stage 1 CKD has a GFR >90 which is normal, but there can be a structural abnormality with the kidney that leads to this classification (ie. microalbuminuria)

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9
Q

How much of the medicare budget is spent on CKD?

A

20% despite CKD making up 1/10 of the medicare population.

It’s very expensive to care for CKD.

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10
Q

What is the most common cause of CKD? The second?

A
  1. Diabetes

2. Hypertension

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11
Q

What are major organ systems affected by CKD?

A 
Cardiovascular - greatly affected
Neurologic
Hematologic
Bone Mineral Metabolism
Electrolytes and Volume Status
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12
Q

How does CKD affect renal sodium handling?

A

CKD decreases the kidney’s ability to secrete or resorb sodium.

Prone to developing hypovolemia and hypervolemia

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13
Q

In CKD we typically recommend patients decrease____ and ___ intake.

A

sodium and water

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14
Q

Potassium handling is primarily mediated by…?

A

Aldosterone

More aldosterone = Less K+

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15
Q

What do recommend to patients in regards to potassium when they have CKD?

A

Limit potassium intake

Avoid medications that cause hyperkalemia (bactrim)

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16
Q

What is the major type of metabolic acidosis in CKD patients? NAGMA or AGMA?

A

NAGMA - Decreased Ammonia production in the proximal tubule leads to increased H+ floating around in the blood because there isn’t enough ammonia to bind it.

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17
Q

In CKD patients with Metabolic Acidosis we recommend..

A

Sodium bicarbonate supplementation.

18
Q

In addition to “GOLDMARK,” two other causes of AGMA are…?

A

Phosphate and Sulfate Retention

19
Q

The Kidney uses alpha 1 hydroxylase to convert….?

A

25 hydroxy Vit D (inactive) –> 1, 25 hydroxy VitD (active calcitrol)

20
Q

What are the 3 treatment options for Renal Osteodystrophy (Secondary hyperparathyroidism)?

A

Give Phosphate Binders - FIRST THING!

Give 1,25 Hydroxy Vit D (Calcitriol) – Brings up serum Ca2+

Use PTH inhibitor - save bones!

21
Q

Describe the effect CKD has in the progression of anemia. (3)

A
  1. Inflammation –> Iron cannot be incorporated well into the RBC’s
  2. Decreased EPO –> Less RBC’s
  3. Decreased RBC life span
22
Q

Describe the effect CKD has on platelets.

A

Platelet dysfunction
Poor platelet adhesion - predisposition to bleeding
Toxin Retention

23
Q

How do you treat platelet dysfunction in the setting of CKD? (2)

A

DDVAP (Desmopressin)

Dialysis - if severe

24
Q

How do you treat anemia in the setting of CKD? What is the goal?

A

Use EPO stimulating agents.
Goal Hgb is 10-12g/dL

If you go over 12 you can cause stroke or HTN.

25
Q

What are major complications of CKD on the cardiovascular system?

A

HTN

Sudden Cardiac Death (SCD), Coronary Artery Disease (CAD) – Due to electrolyte imbalance

Uremic Pericarditis - Due to uremia

26
Q

How do you treat cardiovascular system complications in the setting of CKD?

A

HTN - Diuretics, limit salts, ACE/ARBS, Vasodilators

Dialysis

27
Q

What are two neurologic complications that can arise from CKD?

A

Uremic Encephalopathy - poor cognition and asterixis

Peripheral Neuropathy - peripheral motor and sensory issues (ie.restless leg syndrome)

28
Q

What is asterixis? What treatment should you think of when it presents in the context of CKD?

A

Tremor where you can’t hold your hand out (“STOP”)

Treat with DIALYSIS!

29
Q

How should you treat peripheral neuropathy?

A

Gabapentin

Dopamine Agonists

30
Q

In CKD, describe what pruritis and calciphylaxis are and what could cause them?

A

Pruritis - itching due to hyperphosphatemia

Calciphylaxis - Calcium deposition in blood vessels that manifests on skin as ulcers

31
Q

What is the goal blood pressure for patients with CKD? With CKD and proteinuria?

A

CKD - <140/90

CKD w/ proteinuria - <130/80

32
Q

In patients with acidosis and CKD, we should treat with…?

A

Sodium Bicarbonate or Baking Soda.

33
Q

Do statins slow the progression of CKD?

A

No, but they help the heart.

34
Q

Why do we ask CKD patients to limit protein intake?

A

Protein can lead to an increase in GFR which isn’t good!

35
Q

What are the indications for starting Dialysis in patients with CKD?

A

Acidosis- Unresponsive to bicarb therapy
Hyperkalemia - Unresponsive to medical therapy
Fluid overload - Unresponsive to diuretics
Symptomatic Uremia

36
Q

What are the two ways in which proteins further the progression of CKD?

A

1) Bradykinin increase –> Increased RBF –> Glomerular damage and proteinuria
2) Increased sodium & amino acid resorption –> Macula Densa senses low Na+ –> afferent arteriole dilation –> Increased RBF –> Glomerular damage and proteinuria

37
Q

Can ACE/ARBs cause hyperkalemia? How?

A

Yes, by blocking aldosterone

38
Q

Can beta blockers cause hyperkalemia? How?

A

Yes, by increasing movement of K+ from the ICF compartment to the ECF compartment.

39
Q

Does blood glucose affect the progression of CKD? How?

A

Yes, it increases proteinuria.

This is why it is critical to maintain good blood glucose control

40
Q

What is the goal range of proteinuria that we want for patients with CKD?

A

0.5g protein/day

41
Q

Should you do dialysis if a patient has acidosis? (Or any of the AIEOU symptoms?)

A

You should only dialyze if the patient has a problem UNRESPONSIVE to medical therapy.

In uremia you will automatically treat.

42
Q

At which stage of kidney failure is renal replacement therapy primarily indicated? What is the GFR at this stage?

A

Stage 5 CKD - Kidney Failure, GFR < 15

Patient does not need dialysis if medications have not been fully utilized.

BiB Midterm 3 & Final (10 decks)

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