CKD Flashcards
Kidney damage with ____ or ___ GFR is Stage __ CKD.
GFR= > ____
Increased GFR–> proteinuria, renal hematuria, cystic disease, etc.
normal, increased, 1, 90
____ decrease in GFR is Stage __ CKD.
GFR= ___- 89
Mild, 2, 60
____ decrease in GFR is stage __ CKD.
GFR= __- 59
Moderate, 3, 30
___ decrease in GFR is stage __ CKD.
GFR= __- 29
Severe, 4, 15
Kidney failure is stage __ CKD.
GFR= < ___
This patient will most likely need dialysis.
5, 15
What are the 2 most common causes of CKD?
DM- 44%
HTN- 28%
What can a patient do to prevent progression of CKD? (6)
- control BP
- detect and treat microalbuminuria/ proteinuria
- treat metabolic acidosis
- control blood sugar
- treat reversible causes
- refer to nephro
What can used to treat microalbuminuria/ proteinuria?
ACEi, ARBs, SGLT2, GLP1R agonists, finerenone, protein restriction
What is adapative hyperfiltration?
When nephrons lost/ is not working right, the other nephrons must take over and work harder to keep up.
Name some complications of uremia.
fluid excess/ HTN, hyperkalemia, metabolic acidosis, hyperphosphatemia, anemia, malnutrition
what is the most common cause of fluid excess?
glomerular disease i.e Na retention
What is the treatment for fluid excess?
salt restriction!!!!!!!!
loop diuretics (unless GFR <30)
monitor weight!!
fluid restriction for hypoNa
When should you practice caution when treating edema?
if the patient has edema s/t nephrotic syndrome and is normotensive
excessive restriction can worsen condition
What is the most important factor in progression to ESRD?
HTN (both cause and effect of CKD)
Hypertensive pts with CKD are usually have ____ issues about ___% of the time. ____ restriction is essential as ____ restriction is not beneficial.
volume, 80, Na, fluid
What are the drugs of choice for hypertensive patients with CKD?
diuretics (loop or metolazone GFR <30)
ACEi or ARBs (unless GFR <30)
other HTN meds
Hypertension in a CKD patient should ___ be treated.
ALWAYS
BP goals for…
CKD w/ albuminuria or proteinuria
<130/80
Bp goals for…
hx of CHF or EF <45%
<120/80
BP goals for…
CKD alone
<140/90
What is the preferred diastolic reading for patients with CAD + CKD?
> 70 so to perfuse the coronary arteries appropriately
Blocking the ____ prevents progression of diabetic renal and glomerular disease
RAAS
___ do not prevent the progression of diabetic renal disease.
CCBs
Inhibition of Ang II…
relaxes afferent arterioles more than efferent arterioles which decreases intraglomerular pressure and diminishes adaptive hyperfiltration
What is the cycle of NO life?
The ____ is the primary organ of potassium excretion.
Kidney
Name aggravating factors of hyperkalemia.
acidosis, Type IV RTA, volume depletion, ACEi/ARBs (+ K binder), K sparing, K supplements
Treatment (outpatient) of hyperkalemia include:
dietary restriction, correction of acidosis, d/c supps or drugs, Kayexalate, Veltassa, Lokelma, RRT
What is the goal bicarb?
23-28 mM/L
Metabolic Acidosis usually has ___ ____ which is calculated by taking Na- (Cl+ HCO3)
Anion Gap
What is an aggravating factor of metabolic acidosis?
RTA
Treatment of metabolic acidosis includes:
arm and hammer baking soda (1/2 to 1 tsp/ day)
NaHCO3 tabs- 650 mg TID
What can cause renal osteodystrophy?
hyperphosphatemia
In hyperphosphatemia, the GFR < ___ cc/min
30
When does extraosseous calcification occur?
Ca x Phos > 55
can cause pruritis; Ca builds up outside of bone
Treatment for hyperphosphatemia includes:
dietary restrictions of phosphorus (d/c milk, cheese)
Phosphate binders (e.g. TUMS, calcium acetate, etc.)- decrease PO4 and K
What are the causes of anemia in CKD?
DIMINISHED EPO
deceased life of RBCs
Uremic effect on marrow
blood loss
iron and/or folate def
Treatment of anemia of CKD includes:
iron supps if needed
IV or SQ synthetic EPO (ESAs)
folic acid, B12 if indicated
packed RBCs
What are the most common (5) reversible factors for renal function deterioration?
- volume depletion
- volume excess and CHF
- infection
- UTI
- Nephrotoxic agents
