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Pharmacy Lab > Chronic Kidney disease and end stage renal disease (Dr. Shepler) > Flashcards

Chronic Kidney disease and end stage renal disease (Dr. Shepler) Flashcards

1
Q

Chronic Kidney Disease (CKD) definition

A

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)

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2
Q

End Stage Renal Disease (ESRD) definition

A

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

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3
Q

3 major causes of CKD

A

diabetes mellitus
hypertension
glomerulonephritis

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4
Q

Other causes of CKD

A

polycystic kidney disease PKD

HIV nephropathy

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5
Q

CDK classified based on

A

cause
GFR
albuminuria category

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6
Q

Criteria for CDK

A

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)
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7
Q

AER

A

albumin excretion rate

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8
Q

ACR

A

albumin to creatinine ratio

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9
Q

G3a GFR

A

45-59 Mildly to moderately decreased

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10
Q

G3b GFR

A

30-44 moderately to severely decreased

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11
Q

G4 GFR

A

15-29 severely decreased

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12
Q

G5 GFR

A

<15 kidney failure

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13
Q

Albuminuria category A1

A

<3mg/mmol (ACR)

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14
Q

Albuminuria category A2

A

30-300mg/24hrs (AER) 3-30mg/mmol (ACR)

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15
Q

Albuminuria category A3

A

> 300mg/24hrs (AER) >30mg/mmol (ACR)

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16
Q

Cockroft and Gault equation men

A

CrCl=(140-age)IBW/(Scr x 72)

17
Q

Cockroft and Gault equation women

A 
CrCl= men x 0.85
CrCl= 0.85{(140-age)IBW/(Scr x 72)}
18
Q

Cockroft and Gault formula for estimating GFR in:

A

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)

19
Q

MDRD formula

A

(modification of diet in renal disease) most accurate measure of GFR, includes adjustments of race and gender

20
Q

IBW males

A

50+2.3(inches over 5 feet)

21
Q

IBW women

A

45.5+2.3(inches over 5 feet)

22
Q

Adjusted body weight

A

IBW+0.3(TBW-IBW)

23
Q

Complications of kidney disease

A
  • Build up of waste products in the blood
  • Edema, fluid overload, cardiovascular complications
  • Metabolic acidosis
  • Anemia
  • Mineral and bone disorder (increase in PTH)
24
Q

Build up of waste products in blood signs

A 
increased BUN
pruritus (skin itching)
confusion
nausea, vomiting
anorexia
25
Q

diuretic resistance how happens

A

loops block Na/Cl/K transporters in ascending thick loop, hypertrophy of distal cells
-overcome with thiazides

26
Q

thiazides ineffective when

A

CrCl <30ml/min

27
Q

Na in CKD:

A
  • 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
28
Q

K in CKD

A

-restrict to 3gm/day

29
Q

K goal pre-dialysis

A

4.5-5.5mEq/L

30
Q

High potassium foods:

A

tomatoes
dried fruits
salt substitutes
fresh fruits

31
Q

treatment of hyperkalemia

A

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
32
Q

Dietary phosphorus restricted to____ if _____

A

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

33
Q

3 things lead to increased iPTH

A
  • hyperphosphatemia
  • hpocalcemia
  • decreased Vit D
34
Q

normal phosphorus (PO4-)

A

2.5-4.5mg/dL

35
Q

normal sodium

A

135-145 mEq/L

Pharmacy Lab (12 decks)

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