CKD Flashcards
Shepler 9,10,11,12,13,14
SCr lab value
0.6 to 1.2 mg/dL
BUN lab value
8 to 23 mg/dL
CrCl lab value
75 to 125 mL/min
eGFR
greater than 90
Phos Lab value
2.5 to 4.5 mg/dL
Ca lab value
8.5 to 10.5 mg/dL
Vit D Lab value
20 to 50 ng/mL
PTH NDD lab value
11 to 54 pg/mL
PTH HD lab value
100 to 500 pg/mL
Hb lab value
men – 14 to 18 g/dL
women – 12 to 16 g/dL
TSAT lab value
20 to 30%
ferritin lab value
200 to 500 ng/mL
MCV lab value
80 to 100
RDW lab value
11.5 to 14.5%
treatment of hypertension AND CKD
ace inhibitors (prils)
ARBs (sartans)
treatment of diabetes and CKD
SGLT2 inhibitors (flozins) and metformin
treatment of edema from CKD
diuretics
dialysis
treatment of anemia of CKD
iron therapy –> oral or IV
AND
erythropoietin stimulating agents (ESAs)
treatment of mineral and bone disorder associated with CKD
dietary phos restriction
phosphate binders
calcimimetics
vit D
major causes of CKD
diabetes mellitus
hypertension (with DM equals 60%)
glomerulonephritis
CKD definition
abnormalities of kidney structure
present for over 3 months with implications for health
classification based on cause, GFR, and albuminuria category
markers of kidney damage
albuminuria (AER greater or equal to 30mg/24 hr, ACR greater or equal to 30mg/g)
urine sediment abnormalities
electrolye and other abnormalities due to tubular disorders
abnormalities detected by histology
structural abnormalities detected by imagine
history of kidney transplantation
GFR in CKD
below 60mL/min/1.73 m2
GFR categories
G1 –> over 90 (normal)
G2 –> 60 to 89 (mildly decreased)
G3a –> 45 to 59 (mild to moderate)
G3b –> 30 to 44 (moderate to severe)
G4 –> 15 to 29 (severe)
G5 –> under 15 (kidney failure, ESKD, likely on hemodylasis)
Crockroft and Gault formula
Men –> CrCl = (140 - age)*IBW / (Scr x 72)
Women –> CrCl = same but multiply by 0.85
Crockroft and Gault
estimation for creatinine clearance
accute for patients with stable kidney function
good predictor of GFR and easy to use
tends to overestimate renal function in moderate to severe kidney impairment
MDRD
modification of diet in renal disease formula
most accurate measure of GFR
IBW
men –> 50 + 2.3(inches over 5 feet)
women –> 45.5 + 2.3(inches over 5 feet)
AjBW
IBW + 0.4*(ABW-IBW)
**use if patient is 130% of their IBW
functions of the kidney
excrete waste products of metabolism from the blood
regulate body concentration of water and salt
maintain acid balance of plasma
synthesize calcitriol
secrete hormones
uremia complication
build up of waste products in the blood associated with ESRD
symptoms: increase in BUN, pruritus, confusion, NV, and anorexia
fluid retention complication
edema
fluid overload
cardiovascular complications (increase in systemic vascular resistance/BP)
electrolyte imbalance complication
metabolic acidosis
hyperkalemia
mineral and bone disorder complication
a complex pathway involving phos, Ca, PTH, and activated Vit D
Anemia complication
Hb decreases, supplement iron and ESAs become necessary
treatment of fluid retention (edema)
- restrict fluid (but not necessary if Na+ intake is controlled)
- diuretics (cannot be used without functioning kidneys)
diuretic usage for edema
used to treat volume overload and HTN in patients with renal insufficiency or those that are making some urine
use thiazide if CrCl is over 30mL/min, use loop if under
if renal function declines and loop is maxed, may add a thiazide to overcome resistance
treatment of Na imbalance
1) no salt added diet, under 2g of Na per day or under 5g of NaCl per day (make sure outpatient aware of hidden high sodium content foods like canned soup or hot dogs)
2) saline containing IV solution (maybe)
treatment of K imbalance
restrict to 3 gm/day
1) avoid high potassium foods like tomatoes
2) treatment for hyperkalemia
treatment of hyperphosphatemia
problem for nearly all ESRD patients
1) phosphate binders
2) dietary restrictions
CKD-MBD
increases Phos, decrease Ca, decrease Vit D –> signals the pituitary gland to release parathyroid hormone –> pull Ca back into the blood from the bone –> increased risk of fractures
phosphate binders
bind dietary phosphate which is ingested in the food and the chelate is eliminated in the feces can either contain calcium or not contain calcium
do not give them calcium containing phos binders if they have normal level calcium!
all must be given with meals or they will not work
calcium containing phosphate binder drugs
calcium carbonate (tums) - 40% elemental calcium
calcium acetate (phoslo) - 25% elemental calcium
calcium carbonate (tums)
calcium containing phosphate binder
whatever is happening in the blood will be absorbed in the GI tract and worsen the problem
SE – constipation
do not exceed 1500 mg elemental calcium
calcium acetate (phoslo)
will bind twice as much phosphate in comparison to tums
may produce fewer hypercalcemic events when compared
non calcium containing phosphate binder drugs
sevelamer carbonate (renvela)
lanthanum carbonate (fosrenol)
sucroferric oxyhydroxide (velphoro)
auryxia (ferric citrate)
alumnium hydroxide (amphojel)
magnesium carbonate (mag-carb)
nictonic acid and nicotinamide
sevelamer carbonate (renvela)
if phos is between 5.5 to 7.5, 800mg TID
if phos is greater than 7.5, 1600mg TID
SE – GI upset, NVD
decreased LDL by 15 to 30%
decrease uric acid serum conc (good for gout)
sucroferric oxyhydroxide (velphoro)
needs to be titrated with 1 tablet per day each week
SE – darkened stool due to iron content (but minimal effect on iron)
lanthanum carbonate (fosrenol)
dose - 250 to 750mg TID (but can titrate up to max 1500 to 3000 mg per day)
eliminated in feces with no long term accumulation
auryxia (ferric citrate)
for CKD patients on dialysis
increases TSAT, increases ferritin
aluminum hydroxide (amphojel)
only short term usage
less than 4 weeks
never really used, most of the time theres a better option (potential for aluminum toxicity)
dietary restriction for hyperphosphatemia
intake should be restricted to 800-1000mg per day if phos is above 4.6 in CKD stage 3/4 and above 5.5 in CKD stage 5 and PTH is greater than target range for stage 3, 4, or 5
foods that contain high phos
least to most
beer
cola
shrimp
peanut butter
chicken thigh
frozen pepperoni pizza slice
milk 1%
Mcdonalds cheeseburger
bacon egg cheese biscut
