CKD Flashcards
1
Q
CKD
A
- GFR < 60 ml/min for more than 3 months
- persistent proteinuria*, hematuria, or abnormal urinary sediment
- progressive nephrosclerosis, irreversible reduction in nephron number
2
Q
major function of nephron
A
- glomerular filtration
- tubular reabsorption (passive)
- tubular secretion (active, mainly K)
3
Q
hyperfiltration and CKD
A
- DM or HTN causes hyperfiltration to maintain GFR
- causes hypertrophy of viable nephrons
- increased pressure and flow -> distortion glomerular architecture, sclerosis, loss of remaining nephrons
4
Q
RAAS and CKD
A
- RAAS and AII get activated to maintain GFR with hyperfiltration
- AII causes altered pore sizes -> increased permeability -> protein leak -> microalbuminuria
- AII and aldosterone are also proinflammatory and profibrotic independently
5
Q
proteinuria and CKD
A
- excessive proteins in urine are directly toxic to tubules
- causes tubular injury, inflammation, scarring
6
Q
GFR
A
- measure of how well kidneys are removing waste and excess fluid from blood
- based on SCr, age, weight, gender, body size
7
Q
normal GFR
A
- > 90
8
Q
GFR suggesting kidney dysfunction
A
- < 60
9
Q
GFR that qualifies for dialysis or transplant
A
- < 15
10
Q
serum creatinine
A
- waste product from normal wear and tear produced by muscles at constant rate
- excreted unchanged in kidneys
- as kidney function decreases Cr levels rise
11
Q
high serum creatinine levels
A
- > 1.2 in women
- > 1.4 in men
12
Q
BUN
A
- measure of amount of nitrogen in blood that comes from waste product urea
- urea made when protein is is broken down
- as kidney function decrease, BUN increases
13
Q
normal BUN
A
- between 7-20
14
Q
sx of CKD
A
- no sx until stage 3 or 4
- anemia, weakness, fatigue
- decreased appetite with progressive malnutrition
- sleep problems
- decreased mental sharpness/ encephalopathy
- muscle twitches/ cramps
- pruritis
- uremic syndrome
15
Q
complications of progressive CKD
A
- anemia
- metabolic acidosis
- derangement in vit d, ca, and p metabolism
- volume overload
- hyperkalemia
- uremia
- CV consequences*
16
Q
approach to pt with new renal dysfunction
A
- consider pre-renal, renal, and post-renal etiology
- careful H&P
- SCr/GFR
- urine dipstick, microscopy, spot protein- proteinuria one of first signs
- renal US, advanced imaging
- urinalysis
- consider checking for MM
17
Q
lab data for CKD
A
- 24 hour urine test*- compares urine Cr to SCr
- urinalysis- protein/ albumin
- urine microscopy- cells/ casts/ crystals
18
Q
microalbuminuria definition
A
- 30-300 mg/L
19
Q
macroalbuminuria definition
A
- > 300 mg/L
20
Q
proteinuria
A
- > 150-160 mg
- 1-2 suggests kidney abnormality
- > 3.5 in nephrotic range
21
Q
anemia and CKD
A
- due to decreased EPO production
- dx of exclusion- r/o all other causes
- can give EPO stim agents if Hgb falls < 10
22
Q
vitamin D def and CKD
A
- secondary to decreased active vit d (1,25- OH), very short half life
- kidneys take vit D storage form (25-OH) and active it
- measure storage vit D to assess kidneys- longer half life
23
Q
metabolic acidosis and CKD
A
- secondary to decreased bicarb resorption and generation by kidneys
- treat with bicarb supplementation
24
Q
bone disease and CKD
A
- secondary to abnormalities in complex interaction between vit d, p, ca, and PTH
- excessive bone resorption
- state of bone quiescence- adynamic bone disease
- results in fragile bone matrix and increased risk fx
25
uremia and CKD
- hundreds of toxins accumulate
- urea and Cr elevated, used as surrogate marker for toxins
- systemic inflammation increases
26
Risk factors for dev CKD
- DM*
- HTN*
- autoimmune disease
- older age
- AA or hispanic
- family hx
- previous episode AKI
- proteinuria
- abnormal urinary sediment
- structural abnormalities of urinary tract
27
stage I kidney disease
- GFR > 90
28
Stage II kidney disease
- GFR 60-89
29
stage III kidney disease
- GFR 30-59
30
Stage IV kidney disease
- GFR 15-29
- difficult to control HTN- require loop diuretics
- hyperkalemia*
- +/- uremia
- refer to nephrologist
31
Stage V kidney disease
- GFR < 15 or dialysis
- need renal replacement/ transplant
- discuss end of life
- once on dialysis > 50% mortality within 5 years
32
what do most CKD pts die from
- CV complications
33
most common causes of ESRD
- diabetic glomerular disease*
- HTN nephropathy*
- glomerulonephritis
- autosomal dominant polycystic kidney disease
- other cystic and tubulointerstitial nephropathy
34
treatment for CKD
- primary prevention
- treat underlying disorder
- dialysis
- transplant
35
when to refer pts to nephrologists
- GFR < 30
- rapidly progressive CKD
- poorly controlled HTN despite four agents
- rare or genetic causes CKD
- suspected renal artery stenosis
36
what is the leading cause of ESRD
- DM
37
DM and CKD
- damages BV in kidneys
- elevated blood glucose rises beyond kidneys capacity to resorb glucose
- glucose concentration remains high in fluid -> increasing urine volume
38
what is the goal hbA1C to reduce risk of CKD
- < 7
39
treatment for DM and CKD
- primary prevention- diet/ exercise, weight loss
- tight glucose control < 7
- BP control < 130/80- delays onset of microalbuminuria
40
diabetic nephropathy
- diabetic pts with dev of renal injury
| - first sign= microalbuminuria
41
treatment for diabetic nephropathy
- ACEI/ARB as first line tx even if normotensive
| - diuretics are second line to aide in BP control
42
what is the second leading cause of ESRD
- HTN
43
treatment for HTN and CKD
- salt and water restriction
- BP < 130/80
- weight loss
- pharm therapies- ACEI/ARB
44
why should you be cautious when treating HTN nephropathy with ACEI/ARB
- recommended CKD stages 1-3
- expect worsening of Cr in up to 30% of pts or reduction in GFR 20% from baseline
- if values continue to drop consult nephrology
- contribute to hyperK
