Chronic Kidney disease and end stage renal disease (Dr. Shepler) Flashcards
Chronic Kidney Disease (CKD) definition
progressive loss in renal function over a period of months or years (defined as abnormalities of kidney structure, present for >3 months with implications for health)
End Stage Renal Disease (ESRD) definition
the last stage of chronic kidney disease, when the kidneys can no longer support the body’s needs. Dialysis or transplant is needed to stay alive
3 major causes of CKD
diabetes mellitus
hypertension
glomerulonephritis
Other causes of CKD
polycystic kidney disease PKD
HIV nephropathy
CDK classified based on
cause
GFR
albuminuria category
Criteria for CDK
either of the following following present for >3 months
- Markers of kidney damage (one or more):
- albuminuria (AER>=30mg/24hrs; ACR>=30mg/g)
- urine sediment abnormalities
- electrolyte and other abnormalities due to tubular disorders
- abnormalities detected by histology
- structural abnormalities detected by imagine
- history of kidney transplantation
- Decreased GFR: GFR<60ml/min/1.73m2 (GFR cat. G3a-G5)
AER
albumin excretion rate
ACR
albumin to creatinine ratio
G3a GFR
45-59 Mildly to moderately decreased
G3b GFR
30-44 moderately to severely decreased
G4 GFR
15-29 severely decreased
G5 GFR
<15 kidney failure
Albuminuria category A1
<3mg/mmol (ACR)
Albuminuria category A2
30-300mg/24hrs (AER) 3-30mg/mmol (ACR)
Albuminuria category A3
> 300mg/24hrs (AER) >30mg/mmol (ACR)
Cockroft and Gault equation men
CrCl=(140-age)IBW/(Scr x 72)
Cockroft and Gault equation women
CrCl= men x 0.85
CrCl= 0.85{(140-age)IBW/(Scr x 72)}Cockroft and Gault formula for estimating GFR in:
accurate for patients with stable kidney function
good predictor of GFT and easy to use
tends to overestimate renal function in moderate to severe kidney impairments (counts secretion when only want filtration)
MDRD formula
(modification of diet in renal disease) most accurate measure of GFR, includes adjustments of race and gender
IBW males
50+2.3(inches over 5 feet)
IBW women
45.5+2.3(inches over 5 feet)
Adjusted body weight
IBW+0.3(TBW-IBW)
Complications of kidney disease
- Build up of waste products in the blood
- Edema, fluid overload, cardiovascular complications
- Metabolic acidosis
- Anemia
- Mineral and bone disorder (increase in PTH)
Build up of waste products in blood signs
increased BUN pruritus (skin itching) confusion nausea, vomiting anorexia
diuretic resistance how happens
loops block Na/Cl/K transporters in ascending thick loop, hypertrophy of distal cells
-overcome with thiazides
thiazides ineffective when
CrCl <30ml/min
Na in CKD:
- no need to severely sodium restrict beyond no salt added diet (so<5g NaCl per day)
- use saline containing IV solutions with caution
- make outpatients aware of hidden high sodium foods
K in CKD
-restrict to 3gm/day
K goal pre-dialysis
4.5-5.5mEq/L
High potassium foods:
tomatoes
dried fruits
salt substitutes
fresh fruits
treatment of hyperkalemia
dialysis
- calcium gluconate IV (cardio-protective)
- nebulized albuterol
- insulin+glucose
- sodium polystyrene sulfonate (kayexalate)15-30g btwn dialysis sessions
- sodium bicarbonate not used for ESRD patients
Dietary phosphorus restricted to____ if _____
800-1000 mg per day if:
Phos>4.6mg/dL (CKD stage 3 and 4)
phose>5.5mg/dL (CKD stage 5)
PTH> target range for stage 3, 4, or 5
3 things lead to increased iPTH
- hyperphosphatemia
- hpocalcemia
- decreased Vit D
normal phosphorus (PO4-)
2.5-4.5mg/dL
normal sodium
135-145 mEq/L
