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662 > CKD > Flashcards

CKD Flashcards

1
Q

CKD is defined as?

A
  • Presence of kidney damage or decrease in kidney function for 3 months or longer
    • Seen by markers of damage or pathological abnormalities
    • eGFR <60
    • CKD is classified by: cause, GFR, albuminuria
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2
Q

Glomerulonephritis (GN)

Specific diseses effect glomular filtration

A
  • Lupes nephritis
  • Post-infectous GN
  • Congenital malformations
  • Polycystic kidney disease
  • Acute renal failure
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3
Q

Risk factors for CKD chart

A
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4
Q

Presentation

Stages

A
  • 1/2 usually asymptomatic
  • 3-4 minial symptoms
    • Fatigue, edema, changes in urination (amount, color, frequency)
  • 5
    • Pruritus
    • N/V/constipation
    • Muscle pain
    • Fatigue
    • Bleeding abnormalities
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5
Q

Systems affected by CKD

A
  • Carbia/pulmonary
    • Na retention: volume expansion edema
    • Uremia: pericarditis, decreased contractility
    • Anemia: high CO state, decreased oxygen delivery, left ventricle hypertophy
  • GI
    • Alt tastes, anorexia, N/V, hiccups
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6
Q

CKD stages

A
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7
Q

Cockcroft-Gault equations for calculating GFR?

A
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8
Q

Markers of kindey damage?

A
  • Albuminuria
  • Urine sediment abnormalities
  • Imaging abnormalities
  • Assess these through: Urinalysis, SCr, Blood pressure, serum electrolytes and imaging studies.
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9
Q

What will cause an increase or decrease in SCr?

A

Increase

  • CKD
  • AA
  • Drugs that inhibit tubular secretion
  • Ingestion of meat or creatine supplements

Decrease

  • Reduced muscle mass (elderly, females)
  • Malnutrition
  • Amputation
  • Vegan
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10
Q

Albuminuria catagories and ACR values

A
  • A1 <30
  • A2 30-300
  • A3 >300
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11
Q

Nephrotoxic medications

A
  • NSAIDs, Amphotericin B, Aminoglycosides, Cyclosporine, vancomycin, ACEs, ARBs
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12
Q

Goals of CKD treatment

A
  • Delay progression of CKD to ESRD
  • Appropriate manage risk factors associated with CKD (Albuminuria, DM, HTN, HLD)
  • Prevent and minimize complications associated with CKD (MBD and Anemia)
  • Reduced mobidity and mortality associated with CKD
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13
Q

Albuminuria indication?

Treatment?

Effectiveness?

A
  • ACR >= 30 mg/g or AER >= 30 mg/24 hrs
  • Treatment
    • ACE
    • ARBs
    • CCBs if cant tolerate others
  • Effectiveness
    • With HTN: titrate dose until BP goal lower if tolerated
    • Normotensive: titrate dose as tolerated and proteinuria reduced
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14
Q

Albuminuria check what for when?

A

SCr, BUN, K+ 2-4 weeks after initiation of ACE/ARB

SCr increase

<30% no dose change

30-50 reduce dose and recheck in 1 week

>50% discontinue agent and recheck after 1 week

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15
Q

Control related conditions

DM

HTN

A

DM

  • A1c < 7%
  • if >65 yo or significant comorbidities (stroke, MI, PVD, liver disease), consider goal A1c 7-8%

HTN

  • <140/90 if ACR < 30
  • <130/90 IF ACR > 30
  • TREAT WITH ACE OR ARB
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16
Q

Preventative therapy for CKD

A
  • Aspirin 81 mg daily
  • Vaccines
    • Influenza
    • Pneumococcal
    • Elevated Uric Acid (>6), Start allopurinol
17
Q

Vit D deficiency

Indication

Safety

Monitoring

A
  • 25OHD < 30 ng/mL
  • Ca < 9.5, Phos <5.5 but iPTH remains elevated (use Vit D analog)

Safety

  • Discontnue if Ca > 10.2, Ca x Phos >55, Phos > 4.6
  • Monitor: Check iPTH every 3 months, Ca/Phos monthly for 6 months, Vit D monthly until stable, then every 3 months
18
Q

Nutritiional Vit D use in stage?

Analog?

A
  • 3-4
  • Ergocalciferol
  • Cholecalciferol

Analog

  • Calciferiol
  • Paricalciferol
  • Doxercalciferol
19
Q

CKD-MBD lab goals

20
Q

Treat hyperphosphatemia if?

21
Q

hyperphosphatemia

Initiate treatment when?

A

When elevated phosphorus and/or iPTH levels remain after 2-4 mo of treatment

22
Q

hyperphosphatemia drugs

23
Q

CKD-MBD monitoring

24
Q

Phosphate binders

A
  • Calcium PB, Sevelamer, Lanthanum
  • separted these med by 1 hour before or 3 hours after PB
25
Q

Cinacalcet (calcimimetic)

Only approved for?

A
  • Only approved for ESRD
26
Q

Diagnosing Anemia

A
  • Lab tests
    • CBC + Diff
      • Look at hemoglobin
    • Ferritin
    • Percent transferrin saturation (TSAT)
    • Absolute reticulocyte count
    • Total iron binding capacity (TIBC)
27
Q

Treat anemia if?

A
  • Hgb <12 in females
  • <13 in males
  • Ferritin
    • <= 500 ng/mL
  • TSAT
    • <= 30%
28
Q

Evaluation of Anemia

29
Q

Anemia tx goals

A
  • Increase oxygen carrying capacity
    • Hgb > 11 dont want to be higher than this
    • TSAT >20% same
    • Ferritin > 100 (non-HD) or >200 HD
  • Decrease signs and symptoms of anemia
  • Decrease need for blood transfusion
30
Q

Anemia therapy

A
  • IV/Oral iron
  • Erythropoiesis- stimulating agents (ESAs)
  • Blood transfusion
31
Q

Dont give IV iron if?

A

Pt has infection

32
Q

When do you choose IV Iron?

A
  • TSAT <12
  • Hgb <7
  • Risk of ongoing blood loss
  • Cannot tolerate oral Fe
  • Dont respond to oral
  • Not compliant
  • Hemodialysis
33
Q

Initiate ESAs when?

34
Q

What should you make sure to tell patients when taking Oral Iron?

Interact with?

A
  • Dark stools, urine discoloration
  • Antacids, PPIs, H2RA, levothyroxine
35
Q

Hemodialysis access types

A
  • AV fistula most preferred but must be planned in advance
  • AV graft quicker
36
Q

Peritoneal Dialysis

A
  • Preserves residual kidney function
  • Similar to HD but uses peritoneal membrane and dialysate is instilled into peritoneal cavity
  • Physiologic removal of waste products, mimics, endogenous kidney function
  • Complications: peritonitis and catheter-related infections

662 (24 decks)

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