Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Acute Care Seminar 1 > CKD > Flashcards

CKD Flashcards

1
Q

Renal physiology

A

-Maintains water balance
-Maintains proper osmolality of fluids
-Regulates the quantity & concentration of most ECF
-Maintains proper plasma volume
-Maintains proper acid-base balance
-Excretes metabolites & foreign compounds
-Produces Erythropoietin
-Produces Renin
-Converts Vitamin D to its active form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Erythropoietin

A

hormone that stimulates red blood cell production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Renin

A

hormone that influences salt conversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RAAS

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Modifiable Risk Factors for CKD

A

–(HTN)*
-(DM)*
-Smoking
-Frequent NSAID use
-Contrast dye exposure
-Previous acute kidney injury (AKI)
-Presence of proteinuria, abnormal urinary sediment, or structural abnormalities of the urinary tract
-Autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Non-Modifiable Risk factors for CKD

A

-Age > 65 years old
-Minority populations – -African Americans, -Hispanics, Pacific Islanders, American Indians
-Family history of renal disease, DM or HTN
-Acute Glomerulonephritis*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common causes of CKD

A

1 Diabetic nephropathy

#2 Hypertensive nephropathy
#3 Acute Glomerulonephritis
-Autosomal dominant Polycystic Kidney Disease (PKD)
-Obstructive Nephropathies
-Autoimmune disease, like Lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Glomerular Filtration Rate (GFR)

A

Considered the best index of kidney function
Varies with age, sex, body size and declines with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cystatin C

A

Considers age, sex, and race to calculate GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Definition/Criteria for CKD

A

-either of the following are present for >3 months
-Markers of kidney damage-(Albuminuria, urine sediment abnormalities, abnormalities detected by histiology, structural abnormalities, hx of kidney transplant)
-Decreased GFR <60mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ESRD

A

accumulation of toxins, fluid excess and electrolytes imbalances results in uremia or uremic syndrome (symptomatic from elevation of waste products in blood)
Ultimately results in death if the toxins are not removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnostic workup

A

-Check Blood Pressure
-Serum creatinine/GFR (compare to trend)
-CBC & Electrolytes
-Serum protein
-Spot urine for Albumin-to-Creatinine Ratio (ACR = divide albumin concentration in mg by creatinine concentration in grams) to detect albuminuria (1st morning void)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Confirming Disease

A

-Spot urine for ACR x 3 months – ACR > 30mg/g
-GFR < 60 mL/min/1.73 m2
Renal Ultrasound (+/- renal biopsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Assessing progression of disease

A

Calcium, Phosphorus, PTH and Alkaline Phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Screening for CKD in diabetes

A

-Patients with diabetes should be screened annually for CKD

-Initial screening should commence:
—-5 years after the diagnosis of type 1 diabetes
—-From diagnosis of type 2 diabetes

An elevated Albumin/Creatinine ratio should be confirmed in the absence of urinary tract infection with 2 additional first-void specimens collected during the next 3 to 6 months. (B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most patients with diabetes, CKD should attributable to diabetes if

A

-Macroalbuminuria is present
-Microalbuminuria is present
-Presence of diabetic retinopathy
-Type 1 diabetes of at least 10 years duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stage 1 CKD

A

GFR > 90 ml/min
diagnose & treat comorbid conditions, slow progression, CVD risk reduction (NO SYMPTOMS)

18
Q

Stage 2

A

GFR 60-89 ml/min
estimate and follow progression (NO SYMPTOMS)

19
Q

Stage 3a

A

GFR 45-59 ml/min
Evaluate & treat complications; follow progression

20
Q

Stage 3b

A

GFR 30-44 ml/min
Evaluate & treat complications; follow progression

21
Q

Stage 4

A

GFR 15-29 ml/min
prepare for kidney replacement therapy; treat complications

22
Q

Stage 5

A

GFR < 15 ml/min
Kidney replacement therapy when uremia is present

23
Q

CKD is classified based on CGA (Cause, GFR, Albuminuria)-Albuminuria

A

Moderately increased-30-300 mg/g or 3-30 mg/mmol

Severely increased >300mg/g or >30 mg/mmol

24
Q

CKD Managements

A

-Treat underlying etiology
-Avoid loss of nephrons
-Slow progression of disease (ACE inhibitors or ARBs are renoprotective (no dual RAAS therapy)
-Identify all patients that have a solitary kidney
-Refer to Nephrologist

25
Fluid Overload Complication-Tx
Fluid and Na+ restrictions Monitor daily weights Diuretics Need higher doses Escalate doses Dialysis
26
Hyperkalemia
Potassium restricted diet Avoid K+ sparing medications Cautious use of K+ supplements Cautious use of ACE inhibitors Adjust K+ bath if dialyzed Recognize when Hyperkalemia is an emergency
27
Recognize when Hyperkalemia is an emergency
diuretics, insulin (take K+ into cells), glucose (D50) to treat hypoglycemia, kayexalate, IV Ca+ gluconate to reduce myocardial irritability
28
Hyperphosphatemia tx
Keep Phosphorus < 4.6mg/dL Restrict Phosphorus to 800-1000mg/day Phosphate Binders 3 x day with meals GFR < 20-30 mL/min Calcium Carbonate or TUMS / Calcium Acetate or Phoslo / Sevelamer or Renagel Dialysis when ineffective Increased vascular calcification Associated with increased CVD mortality*
29
Hyperphosphatemia can lead to what?
-Leads to decreased levels of ionized Ca+ resulting in diminished calcitrol production and phosphate retention, which also stimulate PTH production -Low calcitrol levels contribute to hyperparathyroidism which leads to bone turnover and hypocalcemia
30
Hypermagnesemia
Avoid Magnesium and Aluminum containing laxatives & antacids Cautious use of supplementation Dialysis if needed
31
Hypocacemia
Maintain normal Ca+ 8.5 – 10.2 mg/dL CALCULATE corrected calcium (correct if less than 6.5 mg/dL) Corrected calcium (mg/dL) = serum calcium (mg/dL) + 0.8 (4.0 - serum albumin g/dL) Calcium supplementation as needed Vitamin D supplementation Phosphate binders can elevate calcium
32
Protein catabolism
Protein restricted diet Adequate calories Avoid states that increase catabolism stress, trauma, infection, immobilization Multivitamin for renal patients (Dialyvite) As disease progresses malnutrition worsens Check Albumin
33
Anemia of chronic disease
Iron supplementation Vitamin supplementation as needed Erythropoietin stimulating agents 2-3 x week
34
Epoetin dosing
-When Epoetin is given SC to adult patients, the dose should be 80 to 120 units/kg/wk (typically 6,000 units/wk) in two to three doses per week. If the initial administration of Epoetin is IV for hemodialysis patients, the dose should be 120 to 180 units/kg/wk (typically 9,000 units/wk), given in three divided doses. Monitor Hbg/HCT every 1-2 weeks until target Hbg/HCT and stable dose have been achieved.
35
Treating HTN in CKD
-Fluid/Na+ restrictions Antihypertensives ACE inhibitor/ARB or Ca+ Channel Blocker if proteinuria present Consider other compelling conditions Statin therapy if > 50 yo or high CV risk
36
Dyslipidemia with CKD
-Treat with statin
37
Derm conditions with ckd: Pruritus associated c/ uremic state
Can improve with initiation of dialysis May need topical moisturizers, glucocorticoids, oral anti-histamines or ultraviolet radiation
38
Derm conditions with ckd: Calciphylaxis
Advanced patches of ischemic necrosis Extensive vascular and soft tissue calcification Almost exclusively in patients with ESRD Limited treatment – stop warfarin, hyberbaric oxygen treatments, experimental treatments
39
Renal transplant considerations
-Life expectancy > 5 years -Asses for CAD and correct -Rule out underlying neoplasms -Rule out latent or indolent infections (HIV/Hepatitis) -ABO compatibility / HLA typing with donor / direct cross matching
40
Immunosuppression post transplant
Glucocorticoids - Solumedrol, Decadron, Prednisone Cyclosporine - Gengraf / Neoral Tacrolimus - FK506 / Prograf Azathioprine - Imuran / Azasan Mycophenolate mofetil - CellCept Sirolimus - Rapamune

Acute Care Seminar 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions