Chronic Kidney disease (Kana) - W2 Flashcards
What 2 diseases does impaired kidney function contribute to?
- heart disease
- CVA
What is very important for slowing the decline of CKD?
early detection
What is the prevalence of CKD in the US?
10%
What groups is it cost effective to screen for CKD?
- DM
- CVD
- HTN
- hyperlipidemia
- obesity
- metabolic syndrome
- smoking
- HIV
- hepatitis C infection
- malignancy
- family hx
- age greater than 60
- tx w/nephrotoxic drugs
What screening tests should you do annually for CKd?
- UA
- urine albumin
- serum creatinine
What is defined as CKD?
kidney damage or GFR<60ml/min for greater than 3 months.
kidney damage = pathological abnormality in blood or urine tests or imaging studies
What are the causes of CKD?
- diabetes mellitus > HTN > glomerulonephritis
What are the stages of CKD?
- kidney damage + normal GFR >90
- kidney damage + mild decrease GFR 60-89
- moderate decreased GFR 30-59
- lots of people are third stage - 15.5 million
- severe decreased GFR (15-29)
- Kidney failure <15
What is the standard for CKD but isn’t the most accurate?
Plasma creatinine
Test that will likely replace plasma creatinine. Not affected by diet, gender, age or muscle mass so more active.
Cystatin C
is affected by steroids
Creatinine clearance
- more accurate than serum
- urine collections unreliable
- overestimates GFR
- drug influences
CKD- epi equation
- now considered to be the most accrate
- includes variables for age, sex, race and serum creatinine
best and most accurate for CKD and good for GFR but must inject radioisotopes and is invasive.
Plasma clearance
4 things to do for treatment of CKD
- treatment of reversible causes of renal dysfunction
- prevening or slowing the progression of renal disease
- treatment of complications of renal dysfunction
- preparation and initiation of renal replacement therapy
What are some revesible causes of renal dysfunction?
- decreased renal perfusion
- Nephrotoxic drugs (renal)
- urinary tract obstruction (post-renal)
How do ACE drugs help with reducing progression?
- reduce intraglomerular pressure
- need to monitor creatinine and potassium
6 ways to slow progression of CKD
- ACE inhibitors
- treat hypertension
- dietary protein restriction
- treat hyperlipidemia
- tight glycemia control in diabetes (AIC <7)
- avoid nephrotoxic agents
tx of hyperlipidemia w/CKD
Statin therapy!!!
traget for LDL is 100
6 complications that can occur with renal dysfunction?
- volume overload
- hyperkalemia
- metabolic acidosis
- hyperphosphatemia
- hyperparathyroidism
- anemia
How do we treat metabolic acidosis?
- sodium bicarbonate supplement
- slows down progression
- prevents bone buffering and muscle breakdown
- watch until levels go above 20
How can we treat hyperphosphatemia?
- dietary phosphorus restrictions
- no dairy, nuts
- 1g per day
-
phosphate binders
- calcium carbonate (tums)
- calcium acetate
- lanthanum carbonate
- sevalamer
- sucroferric oxyhydroxide
what are the reccomendations for the amount of sodium, K, and phos
- 3g sodium
- 2g potassium
- 1g phosphorus
What are the lab values you see with secondary hyperparathyroidism?
high phosphorous
low calcium
high PTH
what can you use to treat hyperparathyroidism but what must you make sure of?
- Drugs
- Calcitriol
- Doxecalciferol
- Paricalcitol
- must make sure phosphorus is down
- drugs activate vitamin D which makes calcium and phosphorus go up
What drug can be used for hyperparathyroidism but doesn’t affect phosphorus or calcium?
- calcimimetic - cinacalecet
- every expensive
- use more w/noncomplicance of phosphorus
When do we give treatment for anemia with CKD and what do we give?
- given when hemoglobin is <10g
- Procrit (Erythropoeitin) can be given in injections.
- make sure no other cause before you start.
What are the 2 types of dialysis?
- hemodialysis - hooked up to machine
- peritoneal dialysis - peritoneum serves as membrane which substances dissolve across.
How do you treat vitamin D deficiency?
- cholecalciferol
- ergocalferol
What are the NORMAL values?
K+
PO4-
HCO3-
vitamin D
PTH
- K+ = 3.5 to 5
- PO4- = 2.5 to 4.5
- HCO3- = should be at least 20
- vitamin D = 30 ng/ml
- PTH = 20 to 65
