CKD Flashcards
Common Causes of CKD
Diabetic Nephropathy
HTN
CKD risk factors
Small gestational birth weight
Childhood obesity
HTN
DM
Autoimmune disease
Advanced age
African
Family Hx
AKI
Protein urea
Structural abnormalities
What is uremia and why does it occur in CKD
Build up of BUN, unable to be filtered by the kidneys
What are complications of uremia and what is the treatment
Anemia
Malnutrition
Abnormal metabolism
Dialysis
Na disturbances in CKD and treatment
Hypernatremia
Diuretics
If refractory to diuretics use HD
What potassium disturbances occur in CKD and how do you treat it
Hyperkalemia occurs d/t inability to filter
May need dialysis
What happens to calcium and phos in CKD and how do we treat
Calcium: Typically low but can be high. Decrease in Vit D and increase in bone turnover. Osteomalacia. If high can lead to CAlciphylaxis which causes calcification of calcium in blood vessels leading to blockages an ischemia.
Phosphorus: Typically high but can be low.
What is the common metabolic disturbance in CKD and how is it managed
Metabolic acidosis which can progress to a gapped acidosis. Occurs d/t the retention of potassium and others cations.
Management: Bicarb, avoid high protein catabolism, watch Na loading
What are CV complications of CKD
CHF, HTN, Anemia, Pericardial disease, death
What is the strongest risk factor for CKD CV M &M
LVH
What are CV complications of CKD on HD
Hypovolemia and hypotension can aggravate ischemia causing myocardial stunning, elevated Troponins (poor prognostic)
What does CKD and an absence of HTN indicate
Decompensated LVH
What are two examples of high CO states in CKD
Anemia
AV fistula
What are hallmarks of pericardial disease in CKD
ST elevation, PR depression, Friction rub, chest pain
What kind of anemia occurs in CKD and why?
Normocytic, normochormic
Lack of EPO production
What effect does CKD have on INR and why
Increases it d/t lack of clotting factor and platelet aggregation
What are the symptoms of CKD anemia
Fatigue, angina, HF, decreased cognition, impaired immunity
Which CKD anemic patients are at high risk for thromboembolism
Hypoalbuminemia and loss of anticoag factors
What neuro abnormalities occur in CKD and why
Changes are d/t uremia
Early: memory, concentration, sleep
Late: hiccups, cramping, twitching
Advanced untreated: myoclonus, seizures, comma, peripheral neuropathy, RLS
Tx: HD
What are GI manifestations of CKD and why
Uremic Fetor: urine odor to breath
N/V
Gastritis, ulcerations, peptic disease, constipation
CKD endocrine disturbances
Elevated glucose levels
Females: low estrogen, menstruation abnormalities, infertility
Males: reduced testosterone, sexual dysfunction, ogliospermia
Dermatological dysfunctions in CKD
Puritis
Hyperpigmentation
Nephrogenic fibrosing induration
What labs are indicated to diagnose CKD
H &H, CMP, Hepatitis pannel, HIV, autoimmune pane l
When is electrophoresis indicated CKD diagnosis
In patients <35 with unexplained CKD
R/O multiple myeloma
What would be the expected diagnosis for Small vs Normal vs Large kidneys on US
Small: CKD
Normal: AKI, diabetic nephropathy, HIV nephropathy
Large: poly cystic disease
When is a renal biopsy indicated
In absence of all other etiologies
What is the GFR for G1-5 CKD
G1: >90
G2: 60-89
G3a: 45-59
G3b: 30-44
G4: 15-29
G5: <15
