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monster management > CKD > Flashcards

CKD Flashcards

1
Q

KDIGO AKI criteria

A

↑ creat 0.3+ within 48 hoursOR↑ creat greater than 1.5x baseline within last 7 daysORurine vol less than 0.5 mL/kg/h FOR 6 HOURS

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2
Q

nephrotic v nephritic

A

Otic = damage to podocytes = holesItic = inflammation = bloody time

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3
Q

focal segmental glomerulosclerosis

A

1 seen clinicallyhypertension (always)nephrotic syndromeasymptomatic or microscopic proteinuriarenal insufficiency↑ risk progress to ESRD

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4
Q

FSGS dx

A

RENAL BIOPSY

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5
Q

FSGS tx

A

corticosteroids + immunosuppressant

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6
Q

IgA nephropathy

A

2 seen clinicallyaka Berger’s - IgA settles in kidneys = glomerulonephritisoften only manifestation is hematuriagood BP w/o large proteinuria often doesn’t progress to ESRD

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7
Q

IgA nephropathy tx

A

BP control w ACE-I or ARBproteinurialt 1g - typically no txgt 1g - 6 mo steroid trial, maybe immunosuppressants

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8
Q

IgA s/s

A

often only manifestation is hematuria

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9
Q

IgA nephropathy and proteinuria relationship

A

lt 1g - typically no txgt 1g - 6 mo steroid trial, maybe immunosuppressants

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10
Q

primary glomerular disease x2

A

FSGSIgA nephropathyAcute GN, MCD, FSGS, MN, MPGN, IgA Nephropathy, Post Infectious GN, Anti‐GBM Nephritis

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11
Q

secondary glomerular disease example

A

SLESLE, Wegner’s Granulomatosis, Vasculitis, Goodpasture’s Syndrome, Hepatitis C, Hepatitis B, HIV

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12
Q

SLE + kidney relationship

A

nephropathy! secondary glomerular diseasemore females, and younger

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13
Q

SLE glomerular disease s/s

A

often present, not always: proteinurianephrotic syndromehematuria

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14
Q

SLE glomerular disease dx

A

renal biopsycomplement (see depression), anti-dsDNA, anti-nuclear ab (positive)

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15
Q

IgA nephropathy dx

A

RENAL BIOPSY

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16
Q

** renal biopsy as dx **

A

FSGSIgA nephropathySLEnephritic syndrome

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17
Q

nephrotic vs nephritic setting

A

OTIC: chronicITIC: acute (biopsy to dx/tx STAT)

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18
Q

nephrotic vs nephritic mechanism

A

OTIC: podocyte injury, changed architecture (scar, matrix deposition)ITIC: inflammation, GBM break, crescent formation

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19
Q

nephrotic vs nephritic onset

A

OTIC: insidiousITIC: abrupt

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20
Q

nephrotic vs nephritic edema

A

OTIC: largeITIC: small - mod

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21
Q

nephrotic vs nephritic BP

A

OTIC: normal - lowITIC: HIGH

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22
Q

nephrotic vs nephritic proteinuria

A

OTIC: LARGEITIC: small - mod

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23
Q

nephrotic vs nephritic hematuria

A

OTIC: eh maybe, maybe notITIC: MOD - LARGE

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24
Q

nephrotic vs nephritic RBC casts

A

OTIC: absentITIC: present

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25
Q

leading cause of CKD in US

A

DIABETIC KIDNEY DISEASE! (diabetic nephropathy)

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26
Q

** diabetic kidney disease dx **

A

CLINICAL PRESENTATION! often r/t poorly controlled DMACR- macro OR - micro + diab retinopathy or T1DM x10 years

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27
Q

** ACR is… **

A

albumin:creatinine ratiomacro: greater than 300 mg/gmicro: 30 - 300 mg/g

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28
Q

consider differentials for diabetic kidney disease if what are seen…

A
  • absence of diabetic retino/neuro pathy- urine sediment- DM less than 5 years- little to no proteinuria
29
Q

proteinuria and diabetic kidney disease

A

YES - think albumin!!!!ACR: micro or macroalbuminuria??

30
Q

** diabetic kidney disease treatment for proteinuria **

A

ACE or ARB- low dose 2.5 mg lisinopril- check BMP 1 week (hyper K, AKI)DONT START / DO DC… IF LATE STAGE 4 good for normotensive albuminuric DM pts if BP can tolerate

31
Q

late stage 4 diabetic kidney disease tx nota bene

A

do not start ACE/ARBdc ACE/ARB if taking

32
Q

** metformin + CKD mgmt **

A

creatinine: 1.5 (f) 1.4 ()AVOID METFORMIN. (lactic acid increase believed) change to glipizide.

33
Q

hypertensive nephrosclerosis

A

2nd leading cause of CKD in USkidney damage d/t htn

34
Q

hypertensive nephrosclerosis risk factors for ESRD progression

A

african americanadvancing agemalesmokerlipid abnormalitiesinsulin resistance

35
Q

** hypertensive nephrosclerosis dx **

A

clinical - systemic signs of chronic, uncontrolled htn

36
Q

hypertension goals - diabetic v non-diabetic

A

diab: less than 130/80non-diab 120/70

37
Q

stage 4 CKD med nota bene

A

thiazides do not work!dc ACE/ARB (or don’t start)

38
Q

AE procardia, hydralazine

A

LE swelling

39
Q

** clonidine + CKD **

A

NO NO NO. missed dose = rebound hypertension- difficult to wean off

40
Q

CKD stages mnemonic

A

90 / 60 / 30 / 15 / less(GFR)

41
Q

CKD: refer to nephrology

A

proteinuriaGFR declinehematuriamultiple renal cysts (incidental or purposeful imaging)resistant hypertensionrecurrent renal stones → urology & nephrology!electrolyte abnormalities (ex: hypercalcemia, hypernatremia)

42
Q

UA dipstick proteinuria equivalencies

A

mg/dL1+ 302+ 1003+ 300 - 5004+ 1000+

43
Q

nephrotic range proteinuria

A

3g +

44
Q

glucose usually not present in urine until…

A

serum glucose over 160-180

45
Q

normal 24 hour urine protein content

A

less than 150

46
Q

UA: leukocyte esterase and nitrite tell you

A

about pyuriareduction product from nitrites: E Coli, enterobacter, citrobacter, klebsiella, proteus

47
Q

urine pH typically

A

6between 4.5 - 7

48
Q

how much renal fxn lost before elevations of creat noted

A

60%

49
Q

CKD + anemia

A

NORMALLYlow blood volume = erythropoetin to increase RBC creationCKD - depressed kidney fxn = no epo = anemia

50
Q

anemia w CKD tx

A

iron PO if tolerated- give with vitamin CESA (epo stimulating agent)

51
Q

increases absorption of PO Fe

A

Vit C

52
Q

renal osteodystrophy/mineral bone disease

A

NORMALLY kidney works with parathyroid gland to manage Ca & PO4CKD- can’t secrete = hyperphosphatemia = less calcium- 2ndary hyperparathyroidism (gland keeps secreting PTH trying to fix)

53
Q

CKD + chronic metabolic acidosis tx

A

bicarb supplement - NaBicarb, NOT baking soda

54
Q

CKD + hyperuricemia tx

A

tx only if uric acid greater than 12REFER IF GOUT

55
Q

** absolute indications for dialysis (ESRD) **

A

Uremic pericarditis/effusionUremicencephalopathyGI BleedingAnorexia/N/VProgressive Malnutrition

56
Q

** relative indications for dialysis (ESRD)

A

↑ serum CrGFR under 10‐15 ml/minRefractory lyte abnormalities (remember K can be managed without dialysis!!)Volume Overload not otherwise manageable

57
Q

ESRD referrals

A

dialysis centersocial workRD

58
Q

PD complications

A
  • peritonitis- fluid/vol mgmt- hypoalbuminemia- glucose management (dialysate has lots of glucose)- non-compliance
59
Q

acute tubular necrosis: general definition

A

d/t ischemia r/t poor perfusion OR nephrotoxic drugs; if sufficient to cause tubular ischemia, will result in loss of tubular fxn

nephrotoxic drugs - include contrast, also cause vasoconstriction leading to ischemia/loss function (pre-tx with fluids, may add bicarb)

60
Q

acute tubular necrosis: 3 phases of injury

A

oliguric
diuretic
recovery (post-oliguric)

61
Q

ATN: oliguric phase

A
  • UOP lt 400 ml/day
  • increased BUN & creat
  • electrolyte disturbances, acidosis, fluid overload (d/t kidney inability to excrete water)
62
Q

ATN: diuretic phase

A

occurs when cause of AKI corrected

  • renal tubule scarring/edema
  • increased GFR
  • daily UOP 400+ ml
  • possible electrolyte depletion from excretion of more H2O & osmotic effects of high BUN
63
Q

ATN: recovery phase

A
  • decreased edema
  • normalization of fluid & electrolyte balance
  • return of GFR to 70% or 80% of normal
64
Q

ATN: treatment

A
  • loop diuretics (Lasix)
  • dialysis (until functional again)
  • dopamine (increase perfusion, but no longer recommended)
65
Q

chronic kidney disease definition

A

GFR under 60 for 3+ mos

+ “kidney damage”: pathologic abnormalities or markers of damage including abn blood/urine tests, imaging

66
Q

CKD: stages 1-5

A 
GFR
1 - 90+
2 - 60 - 89
3 - 30 - 59
4 - 15 - 29
5 - under 15 (ESRD)
67
Q

end stage renal disease definition

A
  • renal fxn under 85%
  • Stage V CKD: GFR under 15 OR dialysis
  • uremia/CVD
68
Q

pharm tx of choice for anemia s/t CKD

A

ESA erythropoesis stimulating agent

monster management (29 decks)

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