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CRRAB II > Chronic Kidney disease (Kana) - W2 > Flashcards

Chronic Kidney disease (Kana) - W2 Flashcards

1
Q

What 2 diseases does impaired kidney function contribute to?

A
  • heart disease
  • CVA
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2
Q

What is very important for slowing the decline of CKD?

A

early detection

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3
Q

What is the prevalence of CKD in the US?

A

10%

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4
Q

What groups is it cost effective to screen for CKD?

A
  • DM
  • CVD
  • HTN
  • hyperlipidemia
  • obesity
  • metabolic syndrome
  • smoking
  • HIV
  • hepatitis C infection
  • malignancy
  • family hx
  • age greater than 60
  • tx w/nephrotoxic drugs
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5
Q

What screening tests should you do annually for CKd?

A
  • UA
  • urine albumin
  • serum creatinine
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6
Q

What is defined as CKD?

A

kidney damage or GFR<60ml/min for greater than 3 months.

kidney damage = pathological abnormality in blood or urine tests or imaging studies

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7
Q

What are the causes of CKD?

A
  • diabetes mellitus > HTN > glomerulonephritis
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8
Q

What are the stages of CKD?

A
  1. kidney damage + normal GFR >90
  2. kidney damage + mild decrease GFR 60-89
  3. moderate decreased GFR 30-59
    1. lots of people are third stage - 15.5 million
  4. severe decreased GFR (15-29)
  5. Kidney failure <15
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9
Q

What is the standard for CKD but isn’t the most accurate?

A

Plasma creatinine

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10
Q

Test that will likely replace plasma creatinine. Not affected by diet, gender, age or muscle mass so more active.

A

Cystatin C

is affected by steroids

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11
Q

Creatinine clearance

A
  • more accurate than serum
  • urine collections unreliable
  • overestimates GFR
  • drug influences
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12
Q

CKD- epi equation

A
  • now considered to be the most accrate
  • includes variables for age, sex, race and serum creatinine
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13
Q

best and most accurate for CKD and good for GFR but must inject radioisotopes and is invasive.

A

Plasma clearance

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14
Q

4 things to do for treatment of CKD

A
  1. treatment of reversible causes of renal dysfunction
  2. prevening or slowing the progression of renal disease
  3. treatment of complications of renal dysfunction
  4. preparation and initiation of renal replacement therapy
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15
Q

What are some revesible causes of renal dysfunction?

A
  1. decreased renal perfusion
  2. Nephrotoxic drugs (renal)
  3. urinary tract obstruction (post-renal)
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16
Q

How do ACE drugs help with reducing progression?

A
  • reduce intraglomerular pressure
  • need to monitor creatinine and potassium
17
Q

6 ways to slow progression of CKD

A
  1. ACE inhibitors
  2. treat hypertension
  3. dietary protein restriction
  4. treat hyperlipidemia
  5. tight glycemia control in diabetes (AIC <7)
  6. avoid nephrotoxic agents
18
Q

tx of hyperlipidemia w/CKD

A

Statin therapy!!!

traget for LDL is 100

19
Q

6 complications that can occur with renal dysfunction?

A
  1. volume overload
  2. hyperkalemia
  3. metabolic acidosis
  4. hyperphosphatemia
  5. hyperparathyroidism
  6. anemia
20
Q

How do we treat metabolic acidosis?

A
  • sodium bicarbonate supplement
  • slows down progression
  • prevents bone buffering and muscle breakdown
  • watch until levels go above 20
21
Q

How can we treat hyperphosphatemia?

A
  • dietary phosphorus restrictions
    • no dairy, nuts
  • 1g per day
  • phosphate binders
    • calcium carbonate (tums)
    • calcium acetate
    • lanthanum carbonate
    • sevalamer
    • sucroferric oxyhydroxide
22
Q

what are the reccomendations for the amount of sodium, K, and phos

A
  • 3g sodium
  • 2g potassium
  • 1g phosphorus
23
Q

What are the lab values you see with secondary hyperparathyroidism?

A

high phosphorous

low calcium

high PTH

24
Q

what can you use to treat hyperparathyroidism but what must you make sure of?

A
  • Drugs
    • Calcitriol
    • Doxecalciferol
    • Paricalcitol
  • must make sure phosphorus is down
    • drugs activate vitamin D which makes calcium and phosphorus go up
25
Q

What drug can be used for hyperparathyroidism but doesn’t affect phosphorus or calcium?

A
  • calcimimetic - cinacalecet
    • every expensive
    • use more w/noncomplicance of phosphorus
26
Q

When do we give treatment for anemia with CKD and what do we give?

A
  • given when hemoglobin is <10g
  • Procrit (Erythropoeitin) can be given in injections.
  • make sure no other cause before you start.
27
Q

What are the 2 types of dialysis?

A
  1. hemodialysis - hooked up to machine
  2. peritoneal dialysis - peritoneum serves as membrane which substances dissolve across.
28
Q

How do you treat vitamin D deficiency?

A
  • cholecalciferol
  • ergocalferol
29
Q

What are the NORMAL values?

K+

PO4-

HCO3-

vitamin D

PTH

A
  • 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

CRRAB II (26 decks)

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