Chronic Kidney Disease & End Stage Renal Disease Flashcards
1
Q
what are modifiable and non-modifiable CKD risk factors
A
modifiable
- diabetes
- hypertension
- history of AKI
- frequent NSAID use
Non-modifiable
- family histroy of kidney disease, diabetes or hypertension
- age 60 or older (GFR declines normally with age)
- race
2
Q
when should a nephrologist get involved in CKD?
A
when the the patient hits stage 4… SO when their GFR falls to 30 or below
- this is when we start seeing abnormalities
- can also be seen with rapid progression of CKD
- significant proteinuria
3
Q
what are indications for the initiation of dialysis?
A
- volume overload
- hyperkalemia
- metabolic acidosis
- uremia
4
Q
what are symptoms of uremia?
A
- AMS (not being able to have clear thoughts)
- Metallic food taste (urea also suppresses appetite)
- pericarditis
- pruritis
- nausea, vomiting, anorexia
5
Q
what are ways to slow progression of CKD?
A
- Blood pressure control: good blood pressure control; goal SBP < 130
- Target A1-C < 7
- avoid insult to kidney: Contrast, nephrotoxic medications
6
Q
how does RAAS inhibition slow progression of CKD?
A
- decrease the pressure in glomeruli
- reduce proteinuria
- prolongs the life of kidney
7
Q
what medications should be adjusted to GFR?
A
- allopurinol
- gabapentin
- reglan
- narcotics
- insulin
- anti-microbials
- methotrexate
- digoxin & other heart medications
8
Q
what systems do CKD affect?
A
- Hematological effects; anemia
- cardiovascular effects
- mineral & bone disorder
- metabolic acidosis
9
Q
detect and manage CKD complications: Anemia
A
- initiate iron therapy if TSAT < 30% and ferritin < 500ng/mL (IV iron for dialysis, oral for non-dialysis CKD)
- individualize erythropoiesis stimulating agent (ESA) therapy: and maintain Hb < 11.5. ensure adequate Fe stores
- appropriate iron supplementation is needed for ESA to be effective
10
Q
detect and manage CKD complications: Mineral and bone disorder
A
- treat with D3 as indicated to achieve normal serum levles
- 2000 IU po qd is cheaper and better absorbed than 50,000 IU monthly
- limit phosphorus in diet (CKD stage 4/5), with emphasis on decreasing packaged products
- may need phosphate binders
11
Q
detect and manage CKD complications: Metabolic acidosis
A
- usually occurs later in CKD
- serum bicarb > 22mEq
- correction of metabolic acidosis may slow CKD progression and improve patients functional status
12
Q
detect and manage CKD complications: Hyperkalemia
A
- reduce dietary potassium
- stop NSAIDs, COX-2 inhibitors, potassium sparing diuretics
- stop or reduce beta blockers, ACEI/ARBs
- avoid salt substitutes that contain potassium
13
Q
how is CKD a coronary artery equivalent?
A
- CKD can cause HTN, volume overload, calcium metabolism problems and proteinuria
- this can increase strain on the heart coronary calcification
- heart failure coronary artery disease arrythmias
14
Q
what are treatments of end stage renal disease?
A
- comfort care
- hemodialysis
- peritoneal dialysis
- kidney transplant
15
Q
- process whereby the solute composition of a solution is altered by exposing the solution to a second solution through a semipermeable membrane
A
Dialysis
