CKD

Question 1

what are two genetic risk factors that blacks have that yield risk to CKD?

Answer 1

sickle cell

APOL-1

Question 2

what are the two most common causes of CKD?

Answer 2

diabetes and hypertension

Question 3

what are the two things to look at when estimating kidney function in CKD?

Answer 3

GFR and albumin in urine

Question 4

what are the three stages of albumin levels in urine for CKD?

Answer 4

A1
A2
A3

Question 5

what is the cutoff for albumin to be A1 level of CKD?

Answer 5

less than 30 mg/g

or 3mg/mmol

Question 6

what is the cutoff for albumin to be A2 level of CKD?

Answer 6

30-300 mg/g

or 3-30mg/mmol

Question 7

what is the cutoff for albumin to be A3 level of CKD?

Answer 7

greater than 300 mg/g

greater than 30 mg/mmol

Question 8

what is the cutoff for bad outcomes with GFR rate in CKD?

Answer 8

60

Question 9

what test should people with diabetes receive every year?

Answer 9

annual spot urine albumin/creatinine and serum creatinine and GFR estimation

Question 10

how many positive urine albumin levels do you need to be diagnosed with CKD?

Answer 10

2 out of 3 monthly tests have to be positive

Question 11

what is the main thing you control in CKD?

Answer 11

blood pressure

Question 12

what is the BP goal in CKD?

Answer 12

less than 130/80

Question 13

what is the first line drug for proteinuria CKD?

Answer 13

ACE and ARB

Question 14

what is second option for CKD and BP treatment?

Answer 14

calcium channel blockade and diuretics

Question 15

aside from BP…in a patient with diabetes and CKD…what are you trrying to control?

Answer 15

the blood glucose…glycemic control

Question 16

how do we treat proteinuria?

Answer 16

ACE or ARB

Question 17

if you dont give ACE or ARB for proteinuria…then you give what class of drugs?

Answer 17

aldosterone blockers…spiranolactone or epleronone

Question 18

if patient is being treated for proteinuria and is on ACE or ARB…what do you have to keep an eye on?

Answer 18

potassium levels…often lead to hyperkalemia

Question 19

what effect does Angiotensin II have on the kidney GFR?

Answer 19

increases because it constricts the efferent arteriole

Question 20

what does ACE/ARB do to help with proteinuria?

Answer 20

dilate the efferent arteriole

Question 21

what is CKD a huge risk factor for?

Answer 21

cardiovascular disease

Question 22

explain why CKD patients get acidosis

Answer 22

the nephrons are lost and remaining nephrons try to compensate by making more ammonium but cannot keep up and you get H+ accumulating in the blood and bicarb gets sucked up

Question 23

in what stage of CKD do you get a metabolic acidosis with anion gap?

Answer 23

very late stage

Question 24

how do we measure acidosis in CKD? what is the goal?

Answer 24

bicarbonate…above 22

Question 25

how do we treat acidosis in CKD?

Answer 25

give alkali agents…

but also dietary changes is good

Question 26

why does hyperkalemia usually occur in CKD?

Answer 26

medications of ACE and ARBs and as a co morbidity…not directly due to CKD

Question 27

how does CKD lead to anemia?

Answer 27

low EPO production

Question 28

what is MBD from CKD?

Answer 28

metabolic bone disease

Question 29

explain how CKD causes MBD?

Answer 29

phosphate is increasing in serum because it cannot be excreted…it binds the calcium and parathyroid senses the low calcium levels and secretes PTH to increase calcium release from bone and leads to bone breakdown

Question 30

once the parathyroid signals for release of calcium from the bone…what happens to blood calcium levels and what can this cause?

Answer 30

they get high…can cause vascular calcification

Question 31

vascular calcification in MBD can lead to what issue?

Answer 31

calciphylaxis

Question 32

what are two treatment approaches for MBD?

Answer 32

give phosphate binders that lower phosphate levels
or
give calcium mimics to decrease PTH release