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clin med GU > Chronic kidney dz > Flashcards

Chronic kidney dz Flashcards

1
Q

Acute kidney dz vs Chronic kidney dz

A

Acute kidney disease: rapid loss of kidney function
commonly reversible
Usually causes by dehydration, blood loss, meds, IV contrast, Obstruction
Chronic Kidney Dz: progressive loss of renal function that persists for more than 3 months
commonly irreversible
Usually caused by long term dz such as HTN and DM

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2
Q

chronic kidney dz results in

A

inability to maintain
acid-base balance
fluid electrolyte balance
excretion of nitrogenous wastes

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3
Q

CKD epidemiology

A

800,000 have CKD
20mill at risk for CKD
Black americans 3x more like to have kidney failure
Hispancis 1.5x more likely

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4
Q

GFR

A

measure how well the kidneys are removing wastes and excess fluid from blood
Norm GFR is 90 or above
GFR below 60 is a sign kidneys are not working properly
A GFR below 15 indicated that a tx plan for kidney failure such a dialysis or kidney transplant is needed

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5
Q

CKD stage 0

A 
increased risk (DM, HTN etc)
≥90
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6
Q

stage 1 CKD

A

kidney damage with norm or increased GFR ≥90

kidney damage is seen with onset of microalbuminuria

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7
Q

stage 2 CKD

A

kidney damage with mildly reduced GFR 60-89

kidney damage is seen with onset of microalbuminuria

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8
Q

stage 3 CKD

A

moderatly reduced GFR 30-59

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9
Q

stage 4 CKD

A

severly reduced GFR 15-29

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10
Q

stage 5 CKD

A

over renal failure dialysis <15

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11
Q

serum Cr

A

Waste product that develops from normal wear and tear on the body muscles

Normal levels vary depending on age, race, body size

A creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly

As kidney function decreases, creatinine level rises

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12
Q

BUN

A

Measures the amount of nitrogen in your blood that comes from the waste product urea

Urea is made when protein is broken down in your body.

A normal BUN level is between 7 and 20

As kidney function decreases, the BUN level rises

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13
Q

24 hr urine

A

compares urine creatinine to blood creatinine to show how much blood the kidneys are filtering

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14
Q

CKD U/A and microscopy show

A

Protein

casts or crystals

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15
Q

microalbuminuria

A

occurs when the kidney leaks small amounts of albumin into the urine
30-300mg/l

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16
Q

macroabluminuria

A

> 300mg/l

17
Q

how to monitor CKD progression

A

CHEM 7, CBC, UA

18
Q

RF for CKD

A 
DM,HTN, Glomerulonephritis
Tubulointerstitial nephritis
Hereditary dz
Obstructive nephropathies
vascular dz
19
Q

what is the leading cause of end stage renal disease

A

DM

26 mil hace DM

20
Q

how does DM lead to kidney damage

A

Damages vessels in the kidney
Elevated blood glucose rises beyond kidneys capacity to reabsorb glucose
Glucose remains diluted in the fluid, raising its osmotic pressure and causing more water to be carried out, increasing urine volume which dilutes sodium and chloride signaling kidney to release more renin, causing vasoconstriction which reduces nutrients supplied to it causing infarct of its tissues

21
Q

DM tx

A

tight glucose control
diet and exercise
BP <140/90

22
Q

diabetic nephropathy

A

diabetic patient with the development of renal injury

1st sign is microalbuminuria

23
Q

what is the mc co-morbidity with diabetic nephropathy

A

HTN

24
Q

what should be recommended to a pt with diabetic nephropathy

A

ACE/ARB due to renal protective properties

addition of diuretic of a 2nd agent to aide in BP control

25
Q

what is the 2nd leading cause of ESRD

A

HTN

26
Q

How does HTN effect CKD

A

HTN accelerates progression of CKD
controlling BP slows decline of GFR
Inhibiting RAAS is effective in lowering BP and reducing microglobinuria

27
Q

HTN tx

A

salt and water restriction
weight loss
pharm therapies

28
Q

HTN nephropathy

A

develops in pts with proteinuria and HTN

29
Q

HTN nephropathy goal

A

lower BP <140/90 in pt wit CKD and HTN

30
Q

HTN nephropathy tx

A

ACE/ARB

use in stages 1-3 with proteinuria

31
Q

what do ACE/ARB do to glomerulus

A

reduce permeability to barrier proteins and limit proteinuria and filtered protein dependent inflammatory signals and decreases golmerular capillary pressure

32
Q

why should you be cautious with ACE/ARB in HTN nephropathy?

A

expect worsening creatinine up to 30% or reduction of GFR of 20% baseline, if values stabilized after initial rise then safe to continue
If values continue to rise d/c and send to nephrologist
Also contribute to hyperkalmeia

33
Q

pts with stage 4 or 5 need to be what

A

require a nephrologist consult for intiation of ACE/ARB dual therapy

34
Q

when to refer to a nephrologist

A 
GFR<30ml/min
Progressive CKD
Poorly controlled HTN despite 4 agents
Genetic CKD
Renal artery stenosis
35
Q

dialysis

A

Process for removing waste and excess water from the blood, and is used primarily as an artificial replacement for lost kidney function in people with ARF or CKD (stage 5

clin med GU (6 decks)

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