CKD 1 Flashcards
Duration of CKD?***
3 months
The combination of CKD and ____ significantly raise the risk of CVD and death.
diabetes
What treatment of patients with ESRD/CKD is a major cause of morbidity and mortality?
dialysis
What is a common cause of death in pts w/ ESRD?
Cardiovascular Disease
What is the life expectancy of age group 40-44 y/o w/ ESRD?
8 years
Which 2 conditions are the major causes of CKD?
DM & HTN
Kidney disease for greater than _____ as evidenced by structural or functional abnormalities with or without decreased GFR.
3 months
CKD is the presence of GFR < ___ for ___ months with or without other signs of kidney damage.
60
3 months
1 abnormality of CKD?
Albuminuria
**Stage 5 CKD is a GFR < ___ and the patient is on dialysis (ESRD)***
ON EXAM
<15
In which stage of Albuminuria should you intervene early to slow progression of CKD?
A2 & A3
(moderately & severely increased)
(3 mg/mmol or more)
What medication is shown to decrease progression in early stages?
ACE inhibitors
What measurement is now included w/ GFR measurements?
Albuminuria
- Pts w/ CKD are usually asymptomatic until GFR is < ___.
- What sxs would they have?
- 15
- Mental foginess, N/V
In which 5 people would you screen for CKD?
- fam hx
- HTN
- DM
- >60 y/o
- Ethnic minorities (Northern Africa, Latin America, Native Americans)
3 complications of CKD
- Anemia
- Coagulopathy
- Pericarditis
uPRO/uCR ratio correlates to the expected grams of ____ in ___ hours.
protein / 24 hrs
4 components of a UA/ urine microscopy
- Sediment analysis
- RBCs / RBC casts (nephritic)
- WBCs / WBC casts (infection)
- Crystals for stones
What test is NOT usually helpful for evaluation of CKD?
24 hour urine
Eval/Labs of CKD
- _____ is not affected by meds that affect the renal tubules
Cystatin C
- What 3 labs will you order once disease has been determined?
- What are 2 other things to look for?
- Electrolytes (Na, K, Ca, Phos)
- CBC
- BUN
- Hyperparathyroidism evaluation
- Serum Protein Electrophoresis (SPEP)
US eval
- _____ suggestive of chronic disease
- ____ from obstruction
- ____ and infiltrative cancers can cause enlargement
- Disparity from _____
- Atrophic kidneys
- Hydronephrosis
- Amyloidosis
- ischemia
The National Kidney Foundation recommends that every pt w/ GFR < ___ (stages __ & __), undergo a nephrology evaluation.
60 / 3 & 4
What is the first step in treating CKD?
Prevention
- Control hyperglycemia
- Meet ACC/AHA guidelines for HTN (but don’t tx too aggressively)
- Review meds
What is the BP goal for pts w/ CKD?
140/80
3 causes of Pre-renal
- Hypotension
- Hypovolemia
- Medications
3 causes of Intrarenal
- Meds (Vanco, Aminoglycosides, NSAIDS)
- IV contrast
- Infection
Cause of post-renal
Obstruction
4 meds which can cause a false + rise in creatinine
(Interfere w/ creatinine secretion and assay)
- Cimetidine
- Trimethoprim
- Cefoxitin
- Flucytosine
Progression often due to what 3 causes unrelated to the original disease
(cause scarring and further decline in kidney function)
- Intra-glomerular HTN & hypertrophy
- Metabolic acidosis
- Tubulointersitial disease
(TIM)
Slowing Progression of CKD
- HTN management
- DM management
- Smoking cessation
- Tx cholesterol
- Renal vitamins (which 4?)
- What type of diet?
- K, Ca, P, Mg
- Low protein diet and water
- ACE inhibitors or ARBs have greatest benefit when GFR is what value?
- With or without proteinuria?
>60 (early on in disease)
- Can usually maintain fluid balance until GFR is __.
- What is a good way to manage volume?
- 15 mL/min
- Na reduction
In which 2 circumstances would you monitor potassium in pt?
- Pts w/ oliguria
- Pts on K sparing meds
Which condition?
- May play a rose in further disease progression
- Can worsen bone disease
- Can worsen cachexia
- Sodium Bicarbonate for tx
Metabolic Acidosis
Disorder in mineral metabolism
- Hyperphosphatemia
- Hypocalcemia
- Low vit D
–> results in?
Secondary hyperparathyroidism
Tx Complications of CKD
- Mechanism differs based on degree of CKD
- If untreated, secondary hyperparathyroidism & renal osteodystrophy occur
- Dietary modifications important in early disease
- Phosphate binders required once GFR is <__.
Hyperphosphatemia
- 25
As GFR decreases, what happens to Phosphorus and Calcium?
- Phosphorus increases
- Calcium decreases
Tx Complications of CKD
- Common problem in CKD
- Several manifestations
- Vit D deficiency
- KDOQI and KDIGO guidelines
Bone Disease
Tx Complications of CKD
- Typically _____ ______
- Usually when GFR <__
- Usually from reduction in erythropoietin (can give erythropoietin prior to dialysis)
- Non-renal causes need to be evaluated
- Normocytic normochromic
- 60
Tx Complications of CKD
- ___ usually develops w/ GFR <___
- Sxs:
- N/V
- Anorexia
- Fatigue
- Confusion
- Platelet dysfunction
- Pericarditis
- Neuropathy
- Sexual dysfunction
Uremia
Values of GFR
- Severely decreased (prep for transplant)
- Kidney failure (transplant)
- 15-29
- <15
Definition:
- Diffusion of small molecules down their concentration gradient across a semi-permeable membrane
Dialysis
5 Indications for EMERGENT dialysis
- Acidosis (Severe Metabolic Acidosis)
- Electrolyte disturbance (Severe hyperkalemia)
- Intoxication (Overdose w/ dialyzable substance)
- Overload (fluid overload unresponsive to diuretic therapy)
- Uremia (BUN >100)
AEIOU
5 indications for NON-emergent dialysis
- HTN (medication resistant)
- Uremia
- Metabolic disturbance (chronic acidosis, hyperkalemia)
- N/V - malnutrition
- Fluid overload (diuretic resistant)
(HUMNF)
Definition
- Retention of nitrogen waste from kidney dysfunction
- Pericarditis
- Neurologic (Seizures, encephalopathy, Asterixis)
- Coagulopathy
Uremia
- Asterixis: tremor, jerking of hand, tongue and feet
4 factors of diffusion of dialysis
- Blood flow rate
- Membrane surface area
- Permeability of membrane
- Time
Definition:
Removal of water from patients circulation
Ultrafiltration
What are the 3 types of Dialysis?
- Standard dialysis (hemodialysis)
- Peritoneal dialysis
- Continuous renal replacement therapy (CRRT)
5 complications of Standard Dialysis
- Hypotension
- Disequilibrium syndrome (HA, lethargy, nausea)
- Dialyzer reactions (Type A - anaphylaxis)
- Clotting / bleeding
- Arrhythmias
What type of dialysis?
- Dialysate solution is introduced via catheter
- Uremic toxins diffuse across capillaries
- Water moves toward the hypertonic dialysate fluid following osmotic gradient
- The “dirty” fluid is drained
Peritoneal Dialysis
- Catheter is placed in peritoneal cavity
- Uremic toxins diffuse across peritoneal capillaries across the peritoneal membrane into the peritoneum
- What are the 3 complications of Peritoneal Dialysis?
- Which one is the major complication?**
(probably on exam)
- PERITONITIS!! (most important)
- Exit site infection
- Poor dialysate drainage
Renal Transplantation
- Best option for renal replacement therapy (if no contraindications)
- Mortality if 2.6X greater on dialysis
- Mortality reduced by 68%
- Wait list is growing
- Median wait time?
2.6 years
