Chronic Renal Disease

Question 0

What infections predispose an individual to CKD?

Answer 0

HIV, Hep C

Question 1

What is the #1 cause of chronic kidney disease in the world?

Answer 1

Diabetes

Question 2

What is the definition of CKD?

Answer 2

Kidney damage or GFR < 60 ml/min for at LEAST THREE Months.

Question 3

What defines “Kidney Damage”?

Answer 3

Pathological abnormality in blood or urine or kidney imaging

Question 4

What is the second leading cause of CKD?

Answer 4

Hypertension

Question 5

What are the five stages of CKD?

Answer 5

1. Kidney damage and normal GFR (>90%)
2. Kidney damage and mild GFR decrease (60-89%)
3. Moderate GFR decrease (30-59%)
4. Severe GFR decrease (15-29%)
5. Kidney failure (<15%)

Question 6

What factors can affect creatinine levels in the blood?

Answer 6

Reduced with low muscle mass
Increased with high protein diet
Drugs

Question 7

What molecular marker is a much better test for kidney function?

Answer 7

Cystatin-C

Question 8

What is the Crockroft Gault formula?

Answer 8

CC= (140-(age x weight))/(72 x Scr)

Question 9

What test is used for the most accurate measurement of CC?

Answer 9

Plasma clearance (invasive)

Question 10

What are the steps of kidney disease treatment?

Answer 10

1. Treat anything acute! Can be reversed.
2. Prevent or slow progression of the disease
3. Treat complications of renal disfunction
4. Prepare and initiate kidney transplant

Question 11

What are the three categories of TREATABLE acute kidney disease?

Answer 11

Pre-renal (decreased flow)
Renal (nephrotoxic drugs)
Post-renal (outflow obstruction)

Question 12

What are key factors/medications in preventing CKD progression?

Answer 12

ACE Inhibitor
HTN treatment
Dietary protein restriction
Glycemic control
Lipid control

Question 13

What complications of CKD oftentimes need to be treated?

Answer 13

Anemia
Hyperkalemia
Volume overload
Metabolic acidosis
Hyperphosphatemia
Hyperparathyroidism

Question 14

What are some key complications of metabolic acidosis? How do you treat it?

Answer 14

Bone disease worsening
Uremic acidosis may lead to muscle breakdown and reduced albumin synthesis

Treat with bicarb

Question 15

How do you treat hyperphosphatemia?

Answer 15

Dietary restriction

Phosphate binders

Question 16

What do you use to treat hyperparathyroidism?

Answer 16

Vitamin D supplements

Question 17

What is the main problem with most hyperparathyroid treatments?

Answer 17

Increase serum calcium and phosphate

Question 18

What steps are key to treating hyperparathyroidism?

Answer 18

1. Treat hyperphosphatemia
2. Vitamin D analogs to treat secondary hyperparathyroidism
3. If 2 doesn’t work, then calcimimetics
4. Treat Vitamin D deficiency with cholecalciferol or ergocalciferol