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Preresidency > CKD > Flashcards

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
Q

Histology is osteitis fibrosa cystica

A

Abnormal osteoid, bone and bone marrow fibrosis and formation of bone cysts with hemorrhagic elements

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26
Q

Considered a uremic toxin

A

PTH

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27
Q

Population at risk for adynamic bone disease

A

Elderly and diabetics

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28
Q

Causes of adynamic bone disease

A
  1. Excessive suppression of PTH production

2. Chronic inflammation

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29
Q

Complications of adynamic bone disease

A

Fractures and bone pain

30
Q

Consequence of chronic hyperphosphatemia

A

Tumor calcinosis

31
Q

Hyperphosphatemia and CVS

A

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
Q

Devastating condition seen exclusively in advanced CKD patients

A

Calciphylaxis

33
Q

Heralds calciphylaxis

A

Livedo reticularis advancing to ischemic necrosis

34
Q

Pathophysiology of calciphylaxis

A

Vascular occlusion with extensive vascular and soft tissue calcification

May occur in absence of hyperparathyroidism

35
Q

This drug is a risk factor for calciphylaxis

A

Warfarin (prevents GLA protein regeneration through Vitamin K)

36
Q

Optimal management of osteitis fibrosa and secondary hyperparathyroidism

A

Prevention

37
Q

Phosphate binders examples

A

Calcium acetate and calcium carbonate

38
Q

Non-calcium-containing polymers

A

Sevelamer

Lanthanum

39
Q

MOA of cinacalcet

A

Calcium channel sensitization of parathyroid cell

40
Q

Target PTH level in CKD

A

150 - 300 pg/mL

41
Q

Leading cause of mortality and morbidity in patients at every stage of CKD

A

Cardiovascular disease

42
Q

Focus of patient care in earlier CKD stages

A

Prevention of cardiovascular complications

43
Q

Low levels of this may promoted rapid vascular calcification

A

Fetuin

44
Q

Largest increment in cardiovascular mortality rate in dialysis patients is associated with

A

Congestive heart failure and sudden death

45
Q

Cardiac troponins and CKD

A

Elevated

46
Q

Heart failure in CKD

A

Diastolic, systolic or both

47
Q

Manifestation of low-pressure pulmonary edema in advanced CKD

A

Shortness of breath and bat wing distribution of alveolar edema fluid

48
Q

AV fistula is associated with

A

High cardiac output state

49
Q

Absence of hypertension in CKD

A

Poor left ventricular state

50
Q

Reverse causation in dialysis

A

Hypertension, hyperlipidemia and obesity portend a better prognosis due to advanced malnutrition-inflammation state with poor prognosis

51
Q

Use of EPO associated with

A

Increased BP and requirement for antihypertensive drugs

52
Q

BP goal in CKD patients with diabetes or proteinuria > 1 g/24 hours

A

< 130/80

53
Q

First line of therapy in hypertension

A

Salt restriction

54
Q

Indication for discontinuation of ACEIs/ARBs in CKD

A

Progressive decline in GFR

55
Q

Hemodialysis should be performed without heparin in pericardial disease because?

A

Propensity to hemorrhage in pericardial fluid

56
Q

Drug associated with pericardial disease

A

Minoxidil

57
Q

Normocytic normochromic anemia observed at this stage

A

Stage 3 CKD

Universal at Stage 4

58
Q

Check this before ESA initiation

A

Adequate bone marrow iron stores

59
Q

Iron therapy increases susceptibility to bacterial infections

A

True

60
Q

ESA use associated with

A

Increase in thromboembolic events

61
Q

Target hemoglobin concentration in CKD patients

A

100 - 115 g/L

62
Q

Why increased risk of thromboembolic events in CKD patients?

A

Nephrotic-range proteinuria leading to hypoalbuminemia and renal loss of anticoagulant factors

63
Q

NOAcs are excreted?

A

Renally

64
Q

Subtle clinical manifestations of uremic neuromuscular disease usually present?

A

CKD Stage 3

65
Q

Peripheral neuropathy at what stage of CKD?

A

Stage IV

66
Q

Urine-like odor on the breath

A

Uremic fetor (urea to ammonia)

67
Q

Nutritional assessment of CKD patient

A
  1. Food diary
  2. Edema-free body weight
  3. Measurement of urinary protein nitrogen
68
Q

Antihyperglycemia agents that need dose reduction

A

Gliptins

69
Q

Metformin and sulfonylureas contraindicated when?

A

Half of normal GFR

70
Q

What GFR value portends a high rate of spontaneous abortion?

A

40 mL/min

71
Q

Manifestation of CKD in males

A

Testosterone deficiency and oligospermia

Preresidency (17 decks)

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