Chronic Renal Failure

Question 1

Does chronic kidney disease often go without symptoms (especially at early stages)?

Answer 1

YES and is not diagnosed without a lab test (serum creatinine and GFR determination).

Question 2

What is the difference between azotemia and uremia?

Answer 2

• azotemia is just the lab for increased blood urea nitrogen (BUN).
• uremia is the lab value plus symptoms.

Question 3

• What is the definition of chronic kidney disease?

Answer 3

kidney damage for > 3 months, as defined by structural or functional abnormalities +/- decreased GFR, manifest by either pathologic abnormalities, markers of kidney damage, or GFR

Question 4

** What are the stages of chronic kidney disease?

TEST QUESTION

Answer 4

Stage 1= GFR > 90 (normal GFR) but have functional abnormality.
Stage 2= GFR 60-89
Stage 3= GFR 30-59
Stage 4= GFR 15-29
Stage 5 (renal failure)= GFR

Question 5

REMEMBER: what is GFR?

Answer 5

GFR= urine x volume/ plasma

Question 6

Do subtle changes in serum creatinine at early stages of CKD mean more or less?

Answer 6

MORE because if your GFR were to go from 1 to 1.5, your GFR would go from 90 to 60!

Question 7

What is the workup for a pt suspected to have CKD besides GFR?

Answer 7

• previous creatinine values
• rule out reversible causes (urinary obstruction…)
• electrolytes (rule out tubular disorders)
• urinalysis (urine sediment for blood, protein, casts)
• ultrasound
• URINE ALBUMIN:CREATININE RATIO (spot is more effective than 24 hour).
• kidney biopsy

Question 8

What is albumin just as important for risk stratification?

Answer 8

it is and independent risk factor CVD

Question 9

**Why do pts get CKD and why do they start dialysis?

Answer 9

1. DM

2. HTN

Question 10

** What is APOL-1?

Answer 10

gene associated with African Americans and is though to provide resistance to trypanosomes but functional significance to the kidney is still not known, but is thought to increase risk for end stage renal disease!

Question 11

***What is the main manifestation of CKD?

Answer 11

CVD. Most pts die from this before they reach end-stage kidney disease. So the name of the game is to improve their cardiovascular health!

Question 12

What symptoms will we see in stage 4 CKD?

Answer 12

fatigue, swelling, nausea, vomiting…but again these are non-specific :(

Question 13

What is chronic kidney disease- mineral and bone disorder (CKD-MBD)?

Answer 13

collective grouping of laboratory abnormalities, bone abnormalities, and vascular calcification leading to CVD, fractures and mortality.

Question 14

What are the hematologic/GI manifestations of late stage CKD?

Answer 14

• anemia (decreased EPO production)
• platelet dysfunction (bleeding tendencies)
• nausea/vomiting
• uremic fetor
• metallic taste
• anorexia, malnutrition
• stomatitis, parotitis
• gastritis, enterocolitis

Question 15

Will you see an acidosis or alkalosis with later stage CKD?

Answer 15

• acidosis due to the inability to clear sulfates, phosphates…
• bone will try to buffer hydrogen ions at expense of calcium and phosphorus.

Question 16

What are the goals of treatment for stage 3 CKD (GFR

Answer 16

• treat reversible causes
• slow/halt progression
• manage associated disorders of CKD
• identify and adequately prepare pt for renal replacement therapy; stage 4.

Question 17

How do we slow the rate of progression?

Answer 17

• control BP (

Question 18

Should you ever have a pt on an ACE and an ARB?

Answer 18

NO!!! Caused HYPERkalemia

Question 19

What is the HgbA1c goal for slowing the rate of CKD progression in diabetics?

Question 20

How do we manage associated disorders of CKD?

Answer 20

smoking cessation, exercise, nutrition (

Question 21

How do we treat the acid/base disturbance?

Answer 21

sodium bicarbonate

Question 22

What are the 3 options for renal replacement?

Answer 22

1. hemodialysis
2. peritoneal dialysis
3. kidney transplant

Question 23

What is the difference between a fistula and a graft for hemodialysis access?

Answer 23

• radio-cephalic fistula= connection of your vein to your artery.
• loop graft= piece of teflon tubing connects artery and vein.

Question 24

When do you need to start dialysis (renal replacement therapy) right away when GFR is below 15?

Answer 24

• pericarditis or pleuritis (“rub”)
• progressive encephalopathy/neuropathy
• fluid overload refractory (not responding) to diuretics
• bleeding due to uremia
• HTN uncontrolled with medications

Question 25

** When does planning for renal replacement begin?

Answer 25

at stage 4 CKD

Question 26

** What option for renal replacement confers the highest survival benefit among all 3?

Answer 26

TRANSPLANT! :)