Chronic Kidney Disease- Das

Question 1

pt presents w/ fatigue and lower extremity swelling; poor appetite, nausea; HA’s; bleeding
BMP: Cr 7, BUN 80; eGFR 10

Answer 1

CKD stage V and uremia

Question 2

it is manifest only as a biochemical abnormality but, eventually, loss of the excretory, metabolic and endocrine functions of the kidney leads to the clinical symptoms and signs of renal failure, collectively referred to as uremia

Answer 2

CKD

Question 3

abnormalities of kidney structure or function, present for more than 3 months, w/ implications for health

Answer 3

CKD

Question 4

albuminuria
electrolyte abnormalities
GFR<60

Answer 4

CKD

Question 5

early increases in serum creatinine leads to _____ changes in GFR

Answer 5

drastic

Question 6

stage 1 CKD (GFR)

Answer 6

> /= 90

Question 7

kidney failure (GFR)

Answer 7

<15

Question 8

signs and sx’s seen when the kidney has failed

Answer 8

Uremia

Question 9

once the patient begins dialysis, will receive what diagnosis

Answer 9

End Stage Renal Disease

Question 10

what are the 4 main causes of kidney failure

Answer 10

Diabetic glomerulosclerosis
Hypertensive nephrosclerosis
Glomerular disease
ADPKD

Question 11

what are the 2 main causes of chronic renal failure

Answer 11

diabetes
HTN

Question 12

how to measure kidney function

Answer 12

GFR through inulin (creatinine in clinic)

Question 13

Cr
BUN
GFR/Cr clearance
urine protein/albumin
UA

Answer 13

measure kidney function

Question 14

one of the key roles of the kidney: to filter plasma so as to excrete waste products and produce urine

Answer 14

GFR

Question 15

what is the most accurate way to measure GFR

Answer 15

Cr clearance in the clinic

Question 16

CKD-EPI formula uses patient’s serum Cr and demographics to measure what

Answer 16

GFR

Question 17

GFR <15 and massive proteinuria=

Answer 17

worst prognosis for CKD

Question 18

how can you diagnose CKD

Answer 18

Labs (blood, UA)
radiographs
renal biopsy

Question 19

on renal US, someone with kidney disease compared to normal kidney will have what appearance

Answer 19

smaller cortex and glomeruli

Question 20

urinary obstruction
glomerulopathies
Myeloma Kidney
HIV nephropathy
Hep C nephropathy

Answer 20

these diseases need specific therapy

Question 21

the risk of ____ from CV event increases as kidney function declines

Answer 21

death

Question 22

avoid ____ to slow the progression of kidney disease

Answer 22

NSAIDs

Question 23

managing bp, proteinuria, diabetes, correction acidosis, smoking cessation can do what for kidney disease

Answer 23

slow the progression

Question 24

bp goal in patients >65 yrs

Answer 24

<150/90

Question 25

bp goal in general for patients with kidney disease

Answer 25

<140/80

Question 26

bp goal if patient has proteinuria

Answer 26

<120/80

Question 27

goal to treat proteinuria

Answer 27

<500 mg and <50% of baseline

Question 28

drugs to reduce proteinuria

Answer 28

ACEis/ARBs SGLT2i

Question 29

drug that prevents reabsorption of glucose

Answer 29

SGLT2i (-glifozins)

Question 30

every pt who has kidney disease needs to be on what drugs

Answer 30

SGLT2i ACEIs/ARBs

Question 31

diabetic who has kidney disease HbA1c goal

Answer 31

b/t 6.5-8

Question 32

what to use to correct acidosis in pt with kidney disease

Answer 32

NaHCO3-

Question 33

HCO3- above _____ slows progression of kidney disease

Answer 33

22

Question 34

if patient has volume overload in kidney disease, how to treat it

Answer 34

limit salt intake lasix

Question 35

this complication of kidney disease is usually seen when GFR is < 20ml/min (more common in AKI though)

Answer 35

hyperkalemia

Question 36

how to treat hyperkalemia

Answer 36

low K+ diet lasix

Question 37

this is commonly seen when GFR is <60 and kidneys lack erythropoietin production

Answer 37

anemia

Question 38

Hb goal for patient with CKD

Answer 38

10-11 mg/dl

Question 39

associated with CKD b/c PTH is working more to move Ca2+ out of bone to blood

Answer 39

mineral bone disease

Question 40

how to manage secondary hyperparathyroidism seen in pt w/ CKD

Answer 40

control phosphorus give active vitamin D give cinacalcet remove parathyroid

Question 41

why does secondary hyperparathyroidism happen in pt with CKD

Answer 41

kidney unable to produce active vitamin D and there is hypocalcemia and hyperphosphatemia (PTH works overdrive to compensate)

Question 42

pt presents with twisted hand and perioral numbness after parathyroidectomy

Answer 42

Hungry bone syndrome

Question 43

pt has significant sx's and all organs basically effected (result of uremic toxins in blood)

Answer 43

uremia

Question 44

pt w/ CKD with signs and sx's needs to be referred for what

Answer 44

dialysis transplant

Question 45

2 types of dialysis

Answer 45

hemodialysis peritoneal dialysis

Question 46

when to refer for renal transplant

Answer 46

GFR<20 ml/min

Question 47

MoA of cinacalcet

Answer 47

decreases PTH and decreases Ca2+ in the serum