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CKD Flashcards

1
Q

Thiazide diuretics and CKD

A

Limited utility in stages 3 to 5 so that administration of loop diuretics may be needed

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2
Q

Combination of loop diuretics with this may be helpful

A

Metolazone

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3
Q

Indication to start dialysis in relation to diuretic use

A

Diuretic resistance with intractable edema and hypertension

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4
Q

Cause of acute-on-chronic kidney disease

A

Hypoperfusion

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5
Q

Predominant method of potassium excretion in the kidney

A

Aldosterone-dependent secretion in the distal nephron

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6
Q

Medications that inhibit potassium secretion

A

RAS inhibitors, spironolactone, amiloride, eplerenone and triamterene

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7
Q

Renal diseases that affect the distal nephron that cause hyperkalemia

A

Obstructive uropathy

Sickle cell nephropathy

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8
Q

Hypokalemia in CKD

A

Rare and usually associated with poor oral intake

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9
Q

CKD patients produce less of this causing metabolic acidosis

A

Ammonia

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10
Q

Electrolyte abnormality that impairs ammonia excretion

A

Hyperkalemia

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11
Q

This combination is present in patients with early stages of CKD, those with DM nephropathy and those with TIN or obstructive uropathy

A

Hyperkalemia with hyperchloremic metabolic acidosis

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12
Q

Anion gap in early and late CKD

A

NAGMA in early

HAGMA in late (due to retention of anions)

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13
Q

Recommendation for alkali supplementation

A

When bicarbonate falls below 20 - 23 mmol/L

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14
Q

Indication for water restriction in CKD

A

Hyponatremia

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15
Q

Potassium-binding resins

A

Calcium resonium
Sodium polystyrene
Patiromer

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16
Q

Mild degrees of metabolic acidosis can cause

A

Protein catabolism

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17
Q

Classic lesion of secondary hyperparathyroidism

A

Osteitis fibrosa cystica

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18
Q

High bone turnover with high PTH

A

Osteitis fibrosa cystica

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19
Q

Lower bone turnover with low or normal PTH

A

adynamic bone disease

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20
Q

GFR level below which phosphate retention occurs starting the chain of events

A

60

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21
Q

Class of FGF-23

A

Phosphatonins

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22
Q

FGF-23 secreted by

A

Osteocytes

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23
Q

Ways FGF-23 maintains normal serum phosphorus

A
  1. Increased renal phosphate excretion
  2. Stimulation of PTH
  3. Suppression of formation of activated Vitamin D, leading to diminished absorption in GI tract
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24
Q

High levels of FGF 23 is risk factor for

A

LVH and mortality

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25
Histology is osteitis fibrosa cystica
Abnormal osteoid, bone and bone marrow fibrosis and formation of bone cysts with hemorrhagic elements
26
Considered a uremic toxin
PTH
27
Population at risk for adynamic bone disease
Elderly and diabetics
28
Causes of adynamic bone disease
1. Excessive suppression of PTH production | 2. Chronic inflammation
29
Complications of adynamic bone disease
Fractures and bone pain
30
Consequence of chronic hyperphosphatemia
Tumor calcinosis
31
Hyperphosphatemia and CVS
Increased vascular calcification by eposition in media of coronary arteries and heart valves Change in gene expression in vascular cells to osteoblast-like profile
32
Devastating condition seen exclusively in advanced CKD patients
Calciphylaxis
33
Heralds calciphylaxis
Livedo reticularis advancing to ischemic necrosis
34
Pathophysiology of calciphylaxis
Vascular occlusion with extensive vascular and soft tissue calcification May occur in absence of hyperparathyroidism
35
This drug is a risk factor for calciphylaxis
Warfarin (prevents GLA protein regeneration through Vitamin K)
36
Optimal management of osteitis fibrosa and secondary hyperparathyroidism
Prevention
37
Phosphate binders examples
Calcium acetate and calcium carbonate
38
Non-calcium-containing polymers
Sevelamer | Lanthanum
39
MOA of cinacalcet
Calcium channel sensitization of parathyroid cell
40
Target PTH level in CKD
150 - 300 pg/mL
41
Leading cause of mortality and morbidity in patients at every stage of CKD
Cardiovascular disease
42
Focus of patient care in earlier CKD stages
Prevention of cardiovascular complications
43
Low levels of this may promoted rapid vascular calcification
Fetuin
44
Largest increment in cardiovascular mortality rate in dialysis patients is associated with
Congestive heart failure and sudden death
45
Cardiac troponins and CKD
Elevated
46
Heart failure in CKD
Diastolic, systolic or both
47
Manifestation of low-pressure pulmonary edema in advanced CKD
Shortness of breath and bat wing distribution of alveolar edema fluid
48
AV fistula is associated with
High cardiac output state
49
Absence of hypertension in CKD
Poor left ventricular state
50
Reverse causation in dialysis
Hypertension, hyperlipidemia and obesity portend a better prognosis due to advanced malnutrition-inflammation state with poor prognosis
51
Use of EPO associated with
Increased BP and requirement for antihypertensive drugs
52
BP goal in CKD patients with diabetes or proteinuria > 1 g/24 hours
< 130/80
53
First line of therapy in hypertension
Salt restriction
54
Indication for discontinuation of ACEIs/ARBs in CKD
Progressive decline in GFR
55
Hemodialysis should be performed without heparin in pericardial disease because?
Propensity to hemorrhage in pericardial fluid
56
Drug associated with pericardial disease
Minoxidil
57
Normocytic normochromic anemia observed at this stage
Stage 3 CKD | Universal at Stage 4
58
Check this before ESA initiation
Adequate bone marrow iron stores
59
Iron therapy increases susceptibility to bacterial infections
True
60
ESA use associated with
Increase in thromboembolic events
61
Target hemoglobin concentration in CKD patients
100 - 115 g/L
62
Why increased risk of thromboembolic events in CKD patients?
Nephrotic-range proteinuria leading to hypoalbuminemia and renal loss of anticoagulant factors
63
NOAcs are excreted?
Renally
64
Subtle clinical manifestations of uremic neuromuscular disease usually present?
CKD Stage 3
65
Peripheral neuropathy at what stage of CKD?
Stage IV
66
Urine-like odor on the breath
Uremic fetor (urea to ammonia)
67
Nutritional assessment of CKD patient
1. Food diary 2. Edema-free body weight 3. Measurement of urinary protein nitrogen
68
Antihyperglycemia agents that need dose reduction
Gliptins
69
Metformin and sulfonylureas contraindicated when?
Half of normal GFR
70
What GFR value portends a high rate of spontaneous abortion?
40 mL/min
71
Manifestation of CKD in males
Testosterone deficiency and oligospermia

Preresidency (17 decks)

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