Chronic Kidney Disease

Question 1

Most common cause of CKD

Answer 1

Diabetic kidney disease followed by vascular disease

Question 2

Definition of stage 1 CKD

Answer 2

normal GFR > 90 with kidney damage

Question 3

Definition of stage 2 CKD

Answer 3

GFR 60-90 with kidney damage

Question 4

Definition of stage 3a CKD

Answer 4

GFR 45-59

Question 5

Definition of stage 3b CKD

Answer 5

GFR 30-44

Question 6

Definition of stage 4 CKD

Answer 6

GFR 15-29

Question 7

Definition of stage 5 CKD

Answer 7

ESRD

GFR < 15

Question 8

At what level of albuminuria is it considered moderately increased?

Answer 8

30-300 mg/g albumin/cr

Question 9

At what level of albuminuria is it considered severely increased?

Answer 9

> 300 mg/g

Question 10

what is the imaging of choice to eval CKD

Answer 10

renal ultrasound

Question 11

indications for renal biopsy

Answer 11

• persistent hematuria with a low GFR or proteinuria
• nephrotic range proteinuria
• CKD of unknown cause (normal or large kidneys on US
• AKI of unknown cause

Question 12

When should pt with CKD be referred to nephrology

Answer 12

• CKD IV aka GFR < 30
• anemia of cKD
• acute, complex or severe cardiovascular disease
• Bone and mineral disorder of CKD
• difficult to manage medication side effects
• K > 5.5 despite treatment
• refractory proteinuria
• resistant HTN (3 meds)
• unexplained GFR decrease > 30% over 4 months

Question 13

Goal BP in patients with CKD

Answer 13

130/80

Question 14

When should two agents be considered as initial therapy for htn

Answer 14

SBP > 20 mmHg above goal

Question 15

What is the recommended salt intake for CKD?

Answer 15

Salt < 2.4 g/day

Question 16

In CKD, what is the lowest HCO3 should be allowed to fall?

Answer 16

should be maintained at or above 22 mEq/L

Question 17

What lab findings characterize CKD-mineral and bone disorder?

Answer 17

Secondary hyperparathyroidism

• low calcium
• high PO4
• high PTH

measure these in all pts with GFR < 60

Question 18

What causes secondary hyperparathyroidism in CKD?

Answer 18

• phosphate retention due to decreased GFR
• decreased free calcium
• decreased 1,25-dihydroxyvitamin D

Question 19

In diabetic, what should you do if microalbumin is positive?

Answer 19

• confirm with 2 out of 3 sample over the next 3-6 months due to variability in urine albumin excretion
• treat with ACE/ARB

Question 20

How should you counsel pt with CKD on protein intake?

Answer 20

reduce dietary protein intake to 0.8-1.0 g/kg/d

moderately low protein diet

Question 21

Hb goal of erythropoeisis stimulating agents

Answer 21

Hb goal should not exceed 11 g/dL