Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

830 > CKD + CKD Progression > Flashcards

CKD + CKD Progression Flashcards

1
Q

CKD Definition

A
  • Abnormalities in kidney structure or function present for 3 months or more, WITH IMPLICATIONS FOR HEALTH
  • OR eGFR < 60 mL/min/1.73 m^2 via the MDRD or CKD-EPI equation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Kidney Structural Abnormalities

A
  1. Albuminuria >= 30 mg/day
  2. Presence of hematuria or red cell casts in urine
  3. Electrolyte and other abnormalities due to tubular disorders
  4. Abnormalities detected by histology (biopsy)
  5. Abnormalities detected by imaging
  6. History of kidney transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Steps for Delaying CKD Progression

A
  • Reduce proteinuria
  • Control BP
  • Glycemic Control (patients with DM)
  • Other interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Albuminuria/Proteinuria Assessment

A
  • Albumin is a subtype of protein

- 24-Hr Urine Creatinine to calculate Albumin excretion rate (AER) and protein excretion rate (PER)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ratios with Creatinine

A
  • Single urine sample collected from patient
  • Albumin: Creatinine ratio (ACR)
  • Protein:Creatinine Ratio (PCR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Urine Dipstick

A
  • Single urine sample collected from patient
  • Protein reagent strip
  • Results considered qualitative
  • Follow-up with quantitative measure (ACR, AER, PCR, PER)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A1 Albumin/Protein Levels

A
  • ACR/AER: <30
  • PCR/PER: <150
  • Normal to mild
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A2 Albumin/Protein Levels

A
  • ACR/AER: 30-300
  • PCR/PER: 150-500
  • Moderate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A3 Albumin/Protein Levels

A
  • ACR/AER: >300
  • PCR/PER: >500
  • Severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

BP Control - Lifestyle Modification

A
  • Achieve/maintain health body weight: BMI 20-25
  • Lowering sodium intake unless C/I: <2g per day
  • Exercise program compatible with CV health and tolerance: at least 30 minutes 5x/week
  • Limit alcohol intake: Women =<1 drink/day, Men =<2 drinks/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NON-DM + CKD BP Targets

A
  • A1: <140/90

- A2/A3: <130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NON-DM + CKD BP Agents

A
  • A1: Any agent except loop diuretics

- A2/A3: ACE-I/ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DM + CKD BP Targets

A
  • A1: <140/90

- A2/A3: <130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DM + CKD BP Agents

A
  • A1: Any agent except loop diuretics

- A2/A3: ACE-I/ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

BP Agents + Decreasing Proteinuria/Albuminuria

A
  • 1st line: ACE-I or ARBs (DON’T COMBINE)

- Alternative agent: NDP CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

BP + CKD Goals of Therapy

A
  • Decrease amount of protein/albumin in urine
  • Prevent progression from A2 to A3
  • Slow GFR loss
17
Q

Monitoring ACEI/ARB

A
  • Monitor K+ and SCr within 1-2 weeks of starting or increasing dose
  • Discontinue if SCr increased more than 50% or eGFR decreases more than 50% from baseline
  • Optimizing BP is also beneficial for proteinuria
18
Q

Serum K+ and ACEI/ARBs

A
  • If K+ 5-5.5 mEq/L, decrease ACEI/ARB by 50% and recheck

- If K+ is >5.5 mEq/L, discontinue the ACEI/ARB and recheck

19
Q

eGFR + ACEI/ARB

A
  • If eGFR decreases by 30-50%, decrease ACEI/ARB by 50%, repeat process until eGFR is within 30% of baseline
  • If eGFR has decreased by more than 50%, discontinue the ACEI/ARB and recheck
20
Q

CKD + BP 1st Principles

A
  • Considered high risk for CV disease
  • Most will require 2+ antihypertensive agents to achieve target blood pressure
  • With exception of ARB or ACEI in CKD patients with albuminuria, no strong evidence to support preferential use of any particular antihypertensive agent
  • Consider half-life of drug and dose adjustment according to CKD stage
21
Q

Thiazide Diuretics

A
  • Hydrochlorothiazide: CrCl < 30 mL/min, decreased diuretic efficacy (BP may be preserved)
  • Chlorthalidone: Longer half life than HCTZ, may contribute to better BP control, may be effective at lowering renal function more than HCTZ
  • Metolazone: effective at CrCl < 30 mL/min
  • Often used in combination with loop diuretics for additive diuresis (dual nephron blockage)
22
Q

Loop Diuretics

A
  • Considered when fluid overload also present
  • Can be used in all stages of CKD (decreased diuresis with lower eGFR)
  • Typically larger doses required with decreased renal function
23
Q

Calcium Channel Blockers

A
  • NDP: antiproteinuric activity

- Amlodipine: AE of edema is a concern

24
Q

Beta-Blockers

A
  • Masks signs and symptoms of hypoglycemia

- Atenolol and bisoprolol renally eliminated: initiate at smaller doses

25
Q

Aldosterone Antagonists

A
  • Shown to decrease urine albumin excretion when added to ACEI or ARB
  • USE WITH CAUTION
26
Q

Potassium Sparing Diuretics

A

-Usually avoided due to hyperkalemia risk

27
Q

Direct Renin Inhibitors

A

-Limited data in CKD

28
Q

HTN + Proteinuria in CKD

A
  • HTN associated with a faster rate of CKD decline
  • Proteinuria associated with faster rate of GFR decline
  • Proteinuria and decreased GFR can worsen BP
  • Agents used to decrease proteinuria are also BP agents
  • BP lowering itself may decrease protein excretion
29
Q

Glycemic Control

A
  • Diabetic Nephropathy (CKD + DM) - microvascular complication of DM
  • Intensive DM management with goal of achieving near normoglycemia (A1c =<7%) has been shown to delay onset/progression of urinary albumin excretion and slow GFR loss
30
Q

DM + CKD First Line

A
  • Metformine
  • Effective and safe, inexpensive, and may reduce risk off CV events and death
  • C/I if eGFR < 30 mL/min/1.73 m^2
  • If already on therapy and eGFR is 30-45 mL/min/1.73 m^2 then consider cutting the dose in half
  • Initiating Metformin when eGFR is 30-45 is not recommended
  • Calculate eGFR at least annually
  • Patients have increased risk of hypoglycemia with these disease combinations
31
Q

DM + CKD 2nd Line Options

A
  1. SGLT2i

2. GLP-1RA

32
Q

GLP-1RA

A
  • Dulaglutide (Trulicity), Liraglutide (Victoza), Semaglutide (Ozempic)
  • Demonstrated direct renal benefits (appear to possibly slow CKD progression)
  • Reduced risk of CVD events
  • No renal dose adjustments needed
33
Q

SGLT2i

A
  • Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
  • Independent of glycemia benefits, demonstrated direct renal benefits
  • Decreases intraglomerular pressure, decreases albuminuria, slows GFR loss
  • Reduced risk of CVD events
  • C/I in patients with eGFR < 30 mL/min/1.72 m^2, EXCEPT with Invokana, if they are already on the medication, and patient has A3 albuminuria, then may continue with therapy
  • C/I with dialysis
34
Q

Blood Glucose Optimization Summary

A
  • Tight glycemic control - delays onset/progression of diabetic nephropathy
  • Metformin is 1st line, but be cautious with eGFR
  • Preferred second lines are GLP-1RA and SGLT2i due to direct renal benefits and reduced CVD events
  • Consider how oral agents are eliminated
  • Insulin is appropriate at all levels of CKD
  • Patients with CKD and DM are at an increased risk of hypoglycemia, so ensure they are aware of the signs/symptoms and how to treat this
  • Encourage self blood glucose monitoring when appropriate

830 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions