CKD Flashcards
Who is MC affected by CKD?
AAs, Hispanics
Describe acute kidney disease
- Rapid loss of function
- Commonly reversible
- Usually caused by dehydration, blood loss, meds, IV contrast, obstruction
Describe chronic kidney disease
- Progressive loss of renal function more than 3 mos
- Commonly irreversible
- Caused by long term diseases such as DM, HTN
CKD results in an inability to maintain:
- Acid base balance
- Fluid and electrolyte balance
- Excretion of nitrogenous wastes
How is GFR calculated?
From serum Cr level using age, weight, gender, body size
What does the GFR measure?
How well kidneys are removing wastes and excess fluid from the blood
Normal GFR value?
90 or higher
GFR below 60 indicates:
Kidneys not working properly
GFR below 15 indicates:
Dialysis or transplant needed
Describe uremic syndrome
- Clinical systemic manifestations of CKD
- A/w azotemia (accumulation of urea and other toxins)
Define frost in a CKD patient
Urea excreted by sweating crystallizes on skin (late stage CKD)
Describe microalbuminuria
Kidney leaks small amts of albumin into urine
Describe nephron injury in CKD
- Initially remaining functioning nephrons experience hyperfiltration to compensate and maintain GFR
- This leads to RAAS cycle (glomerular capillary HTN) and more damage results
What is the leading cause of ESRD?
DM
How does DM cause kidney damage?
- Elevated glucose raises osmotic pressure causing increased urine volume
- Kidney senses low BP, releases more renin to vasoconstrict and retain water
Describe diabetic nephropathy and the first sign of it
- DM pt w/development of renal injury
- Microalbuminuria
What is the MC comorbidity of diabetic nephropathy?
HTN (due to high glucose causing increased urine output, kidney thinks low BP and stimulates RAAS)
Treatment of diabetic nephropathy
- ACEI/ARB even in normotensive pts because it is renal protective
- Diuretic to aid in BP control
When to refer a pt to nephrologist
- GFR less than 30 (stage 4/5)
- Rapidly progressive CKD
- Poorly controlled HTN despite 4 agents
- Rare or genetic causes of CKD
- Suspected renal artery stenosis
Role of dialysis in CKD
“Holding measure” until renal transplant can be performed
How does ultrafiltration occur in hemodialysis?
Increase the hydrostatic pressure across dialyzer membrane
Describe peritoneal dialysis
- Performed at home by patients often w/o help
- Can be done with little to no specialized equipment
- Less efficient than hemodialysis but is done for longer period of time to compensate
