Chronic Kidney Disease and Dialysis

Question 1

Two criteria to meet for a chronic kidney disease diagnosis

Answer 1

Abnormalities in structure and function of the kidney (progressive decline in number of working nephrons)

Must be present for more than 3 months

Question 2

Three drug types to avoid in patients with chronic kidney disease

Answer 2

NSAIDs

Aminoglycosides

IV contrast

Question 3

True or false. SGLT2 inhibitors can only be used in chronic kidney disease patients who also have diabetes.

Answer 3

False

Question 4

Substance used to remove impurities in peritoneal dialysis

Answer 4

Dialysate

Question 5

Potassium levels are maintained in chronic kidney disease until GFR falls below this level

Answer 5

GFR <10

Question 6

Most and second most common causes of chronic kidney disease

Answer 6

MCC = Diabetes

Second = Hypertension

Question 7

Hypertension goals and treatment in patients with chronic kidney disease

Answer 7

Goal is <130/80

Use ACE inhibitors/ARBs

Question 8

As GFR declines in chronic kidney disease, how will levels of phosphate and calcium also change?

Answer 8

Calcium and phosphorus have an inverse relationship

Kidneys can’t activate vit D

Low vit D means less calcium absorption from food

Serum phosphate increases as calcium goes down and kidneys can’t keep up with excretion

Question 9

Why might ecchymosis, purpura, petechia, gingival bleeding, and oozing from canula sites occur in chronic kidney disease patients?

Answer 9

Decreased platelet aggregation/adhesiveness

Question 10

Diet for patients with renal failure

Answer 10

Low NaPhosK

Also reduce protein and increase calcium

Question 11

Treatment for hyperphosphatemia in chronic kidney disease

Answer 11

Calcitriol + phosphate binder (RenaGel)

May need to supplement vitamin D

Question 12

Can ACE inhibitors and ARBs be used in acute kidney injury, chronic kidney disease, or both?

Answer 12

Good in CKD

Bad in AKI

Question 13

Hyperlipidemia goals in patients with chronic kidney disease

Answer 13

LDL <100
HDL >50
Triglycerides <150

Question 14

Methods to reduce potassium levels in patients with late chronic kidney disease

Answer 14

Loop diuretic to increase potassium excretion

If acidotic, use sodium bicarbonate to increase potassium excretion

If still hyperkalemic use a potassium binding resin (sodium polystyrene/Kayexalate)

Avoid magnesium

Question 15

Which type of dialysis, hemodialysis or peritoneal dialysis is preferred in patients with residual renal function?

Answer 15

Peritoneal dialysis

Question 16

Early symptoms (2) and one late symptom of chronic kidney disease

Answer 16

Early = urinary frequency + nocturia

Late = Itching when near ESRD

Question 17

As well as decreased kidney size, renal ultrasound of a patient with chronic kidney disease might show these three things

Answer 17

Cortical thinning

Scarring

Obstruction

Question 18

Earliest sign of chronic kidney disease in diabetes patients

Answer 18

Microalbuminuria

Question 19

Symptoms for chronic kidney disease often don’t show up until stage 3, at which point GFR is …

Answer 19

GFR <60%

Question 20

Long term vascular access is obtained through this in hemodialysis

Answer 20

Arteriovenous fistulas

Question 21

SCr levels in chronic kidney disease at which to refer a patient to a nephrologist

Answer 21

Women: >1.5mg/dL
Men: > 2.0mg/dL

Question 22

True or false. Chronic kidney disease is irreversible and treatments are aimed at slowing progression

Answer 22

True

Question 23

Best marker for structural damage in the kidney

Answer 23

Proteinuria

Question 24

GFR level at which to start dialysis

Answer 24

GFR 5-9 mL/min

Question 25

Chronic kidney disease causes normocytic normochromic anemia due to decreased erythropoietin. What is the first step in treatments of CKD anemia?

Answer 25

Treat iron deficiency first if present

If Hgb <10 and iron normal, give EPO and aim to maintain Hgb >10