CKD

Question 1

ESRD is defined as?

Answer 1

GFR less than 15 or dialysis/transplantation

Question 2

major causes of ESRD

Answer 2

diabetes, HTN

Question 3

this race has much higher rates of CKD

Answer 3

African Americans

Question 4

Apolipoprotein L1 and CKD are more common in blacks because?

Answer 4

APOL1 variants lyse trypanosoma, but also contribute to CKD

Question 5

ECF volume in ESRD

Answer 5

up and down (hypo following dialysis)

Question 6

common complications of CKD

Answer 6

bone disease, anemia, acidosis, hyperkalemia

Question 7

common contributors to CKD

Answer 7

HTN, proteinuria, uremic toxins

Question 8

management of HTN in patients with CKD

Answer 8

target BP = 130/80; first line tx = ACEI/ARB (sometimes spirinolactone)

Question 9

spirinolactone is contraindicated in patients with?

Answer 9

eGFR below 45, potassium above 4.5

Question 10

proteinuria contributes to CKD by?

Answer 10

increasing inflammatory mediators, which leads to injury

Question 11

tx of proteinuria in pt with CKD

Answer 11

control HTN (ACEI/ARB) + DASH diet + diuretics

Question 12

metabolic acidosis contributes to CKD by?

Answer 12

increasing NH3, activating C3, and causing interstitial fibrosis

Question 13

tx of metabolic acidosis in CKD with _____ leads to improved GFR sclop and nutrition

Answer 13

sodium-bicarb therapy

Question 14

as renal mass decreases, phosphate levels ___, calcium levels ____, and PTH levels ___

Answer 14

increase; decrease; increase

Question 15

increased PTH results in?

Answer 15

leaching of calcium from bones, vascular calcification

Question 16

when there is too much calcium in the blood, you can get?

Answer 16

calcific uremic arteriolopathy (100% 6 month mortality)

Question 17

treatment of bone-mineral disorder: cinacalcet

Answer 17

cinacalcet - tricks calcium receptors in parathyroid into thinking there is more calcium than there is

Question 18

treatment of bone-mineral disorder: phosphate binders

Answer 18

calcium-based are cheaper, but non-calcium based (sevelamer) are better for you, super expensive

Question 19

cheap option for treating bone-mineral disease, but must use cautiously

Answer 19

vitamin D3

Question 20

dialysis causes diffusion of?

Answer 20

creatinine and urea out of blood; bicarb into blood; a little K+ out of blood

Question 21

primary A-V fistulas are made by combining the?

Answer 21

radial artery and cephalic vein

Question 22

ppl on peritoneal dialysis get an infection about once every?

Answer 22

3 years

Question 23

_____ mortality is very high in patients with ESRD (tipping point is GFR <45

Answer 23

cardiovascular

Question 24

patients with acute coronary syndrome and CKD are more likely to present with?

Answer 24

cardiogenic shock

Question 25

anemia occurs in late stage CKD due to?

Answer 25

decreased production of epo and decreased survival of RBCs (abnormal morphology)

Question 26

tx of anemia in CKD

Answer 26

treat iron deficiency first, then give epo stim agents with target of mild anemia level

Question 27

epo stim agents are contraindicated in patients with?

Answer 27

cancer

Question 28

agents to avoid in patients with CKD

Answer 28

NSAIDs, Cox-2 inhibitors, iodinated contrast, gadolinium, biphosphonates, Mg and Ph containing cathartics