CKD

Question 1

Common Causes of CKD

Answer 1

Diabetic Nephropathy
HTN

Question 2

CKD risk factors

Answer 2

Small gestational birth weight
Childhood obesity
HTN
DM
Autoimmune disease
Advanced age
African
Family Hx
AKI
Protein urea
Structural abnormalities

Question 3

What is uremia and why does it occur in CKD

Answer 3

Build up of BUN, unable to be filtered by the kidneys

Question 4

What are complications of uremia and what is the treatment

Answer 4

Anemia
Malnutrition
Abnormal metabolism
Dialysis

Question 5

Na disturbances in CKD and treatment

Answer 5

Hypernatremia
Diuretics
If refractory to diuretics use HD

Question 6

What potassium disturbances occur in CKD and how do you treat it

Answer 6

Hyperkalemia occurs d/t inability to filter
May need dialysis

Question 7

What happens to calcium and phos in CKD and how do we treat

Answer 7

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.

Question 8

What is the common metabolic disturbance in CKD and how is it managed

Answer 8

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

Question 9

What are CV complications of CKD

Answer 9

CHF, HTN, Anemia, Pericardial disease, death

Question 10

What is the strongest risk factor for CKD CV M &M

Answer 10

LVH

Question 11

What are CV complications of CKD on HD

Answer 11

Hypovolemia and hypotension can aggravate ischemia causing myocardial stunning, elevated Troponins (poor prognostic)

Question 12

What does CKD and an absence of HTN indicate

Answer 12

Decompensated LVH

Question 13

What are two examples of high CO states in CKD

Answer 13

Anemia
AV fistula

Question 14

What are hallmarks of pericardial disease in CKD

Answer 14

ST elevation, PR depression, Friction rub, chest pain

Question 15

What kind of anemia occurs in CKD and why?

Answer 15

Normocytic, normochormic
Lack of EPO production

Question 16

What effect does CKD have on INR and why

Answer 16

Increases it d/t lack of clotting factor and platelet aggregation

Question 17

What are the symptoms of CKD anemia

Answer 17

Fatigue, angina, HF, decreased cognition, impaired immunity

Question 18

Which CKD anemic patients are at high risk for thromboembolism

Answer 18

Hypoalbuminemia and loss of anticoag factors

Question 19

What neuro abnormalities occur in CKD and why

Answer 19

Changes are d/t uremia
Early: memory, concentration, sleep
Late: hiccups, cramping, twitching
Advanced untreated: myoclonus, seizures, comma, peripheral neuropathy, RLS
Tx: HD

Question 20

What are GI manifestations of CKD and why

Answer 20

Uremic Fetor: urine odor to breath
N/V
Gastritis, ulcerations, peptic disease, constipation

Question 21

CKD endocrine disturbances

Answer 21

Elevated glucose levels
Females: low estrogen, menstruation abnormalities, infertility
Males: reduced testosterone, sexual dysfunction, ogliospermia

Question 22

Dermatological dysfunctions in CKD

Answer 22

Puritis
Hyperpigmentation
Nephrogenic fibrosing induration

Question 23

What labs are indicated to diagnose CKD

Answer 23

H &H, CMP, Hepatitis pannel, HIV, autoimmune pane l

Question 24

When is electrophoresis indicated CKD diagnosis

Answer 24

In patients <35 with unexplained CKD
R/O multiple myeloma

Question 25

What would be the expected diagnosis for Small vs Normal vs Large kidneys on US

Answer 25

Small: CKD
Normal: AKI, diabetic nephropathy, HIV nephropathy
Large: poly cystic disease

Question 26

When is a renal biopsy indicated

Answer 26

In absence of all other etiologies

Question 27

What is the GFR for G1-5 CKD

Answer 27

G1: >90
G2: 60-89
G3a: 45-59
G3b: 30-44
G4: 15-29
G5: <15