Chronic kidney dz Flashcards
Acute kidney dz vs Chronic kidney dz
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
chronic kidney dz results in
inability to maintain
acid-base balance
fluid electrolyte balance
excretion of nitrogenous wastes
CKD epidemiology
800,000 have CKD
20mill at risk for CKD
Black americans 3x more like to have kidney failure
Hispancis 1.5x more likely
GFR
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
CKD stage 0
increased risk (DM, HTN etc) ≥90
stage 1 CKD
kidney damage with norm or increased GFR ≥90
kidney damage is seen with onset of microalbuminuria
stage 2 CKD
kidney damage with mildly reduced GFR 60-89
kidney damage is seen with onset of microalbuminuria
stage 3 CKD
moderatly reduced GFR 30-59
stage 4 CKD
severly reduced GFR 15-29
stage 5 CKD
over renal failure dialysis <15
serum Cr
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
BUN
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
24 hr urine
compares urine creatinine to blood creatinine to show how much blood the kidneys are filtering
CKD U/A and microscopy show
Protein
casts or crystals
microalbuminuria
occurs when the kidney leaks small amounts of albumin into the urine
30-300mg/l
macroabluminuria
> 300mg/l
how to monitor CKD progression
CHEM 7, CBC, UA
RF for CKD
DM,HTN, Glomerulonephritis Tubulointerstitial nephritis Hereditary dz Obstructive nephropathies vascular dz
what is the leading cause of end stage renal disease
DM
26 mil hace DM
how does DM lead to kidney damage
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
DM tx
tight glucose control
diet and exercise
BP <140/90
diabetic nephropathy
diabetic patient with the development of renal injury
1st sign is microalbuminuria
what is the mc co-morbidity with diabetic nephropathy
HTN
what should be recommended to a pt with diabetic nephropathy
ACE/ARB due to renal protective properties
addition of diuretic of a 2nd agent to aide in BP control
what is the 2nd leading cause of ESRD
HTN
How does HTN effect CKD
HTN accelerates progression of CKD
controlling BP slows decline of GFR
Inhibiting RAAS is effective in lowering BP and reducing microglobinuria
HTN tx
salt and water restriction
weight loss
pharm therapies
HTN nephropathy
develops in pts with proteinuria and HTN
HTN nephropathy goal
lower BP <140/90 in pt wit CKD and HTN
HTN nephropathy tx
ACE/ARB
use in stages 1-3 with proteinuria
what do ACE/ARB do to glomerulus
reduce permeability to barrier proteins and limit proteinuria and filtered protein dependent inflammatory signals and decreases golmerular capillary pressure
why should you be cautious with ACE/ARB in HTN nephropathy?
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
pts with stage 4 or 5 need to be what
require a nephrologist consult for intiation of ACE/ARB dual therapy
when to refer to a nephrologist
GFR<30ml/min Progressive CKD Poorly controlled HTN despite 4 agents Genetic CKD Renal artery stenosis
dialysis
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
