CKD & dialysis/transplant

Question 1

using eGFR numbers, define CKD stages 0 through 5

Answer 1

0 is normal GFR, normal urine
1. GFR over 90
2. GFR under 90
3. GFR under 60
4. GFR under 30
5. GFR under 15

Question 2

4 most common causes of CKD

Answer 2

DM
HTN
GN
cystic kidney disease

Question 3

2 screening tests for CKD

Answer 3

eGR under 60
ACR over 30

having these values for more than 3 months = CKD

Question 4

3 main ways to prevent CKD progression

Answer 4

control BP (can use ACEi or ARB)
manage DM
avoid insults to kidney

Question 5

4 things that are kidney insults

Answer 5

IV contrasts
NSAIDs
dehydration
other nephrotoxic meds

Question 6

when should PCP get nephro involved (3)

Answer 6

• stage 4!
• too fast of progression
• over 3.5g of proteinuria

Question 7

why can ACEi be used in to treat kidney dz? what lab should you monitor when starting it?

Answer 7

• it dilates the efferent arterioles which decreases glomerular pressure, reducing injury, GFR & proteinuria = prolonged kidney life
• check creatinine for 2 wks– if it goes up by more than 25% stop it!!

Question 8

2 reasons we typically dont use 2 RAAS inhibitors

Answer 8

• hyperkalemia
• drops GFR too much

Question 9

4 ways CKD affects CV system

Answer 9

• HTN
• volume overload
• Calcium metabolism issues
• proteinuria

#1 cause of death from CKD; leads to heart failure, CAD, arrhythmias

Question 10

how does CKD affect bone mineralization? 3 ways to treat it

Answer 10

• if it cant make activated vit D then GI cant absorb Calcium causing hypocalcemia. this causes PTH oversecretion so body takes Ca from bones.
• tx: 200IU PO qd D3, limit phosphorous in CKD 4/5, +/- phosphate binders

Question 11

two electrolyte disorders we see in CKD

Answer 11

metabolic acidosis
hyperkalemia

Question 12

how is hyperkalemia managed (4)

Answer 12

• reduce dietary K+
• stop NSAID, COX-2i, K+ sparing diuretics
• stop or reduce BB, ACEi/ARBs
• avoid salt subs that have K+

Question 13

two ways to manage anemia in CKD

Answer 13

• ferritin (start if under 500) & TSAT (keep over 20), oral (non-dialysis) & IV (dialysis) iron repletion
• Epogen replacement– target Hb over 11.5 g/dL, replace iron stores before giving Epogen.

Question 14

5 uremic sx to screen & educate patients about

Answer 14

• AMS
• metallic food taste
• pericarditis
• pruritis
• N/V, anorexia

Question 15

how does the urea level change with GFR changes

Answer 15

urea increases as GFR declines

Question 16

8 meds that you must do dose adjustments in pts w/ CKD

Answer 16

Allopurinol
Gababentin
Reglan
Narcotics
Insulin– hypoglycemia
Antimicrobials
MTX
Digoxin & other heart meds

Question 17

4 main indications for dialysis!

Answer 17

volume overload
hyperkalemia
metabolic acidosis
uremia

Question 18

3 principles of dialysis

Answer 18

• diffusion: gets urea and K+ out & moves Ca and bicarb in
• ultrafiltration: pressure in blood to get water out
• convection: to get the bigger molecules out

Question 19

best access for hemodialysis done via fistula or grafts

Answer 19

aterio-venous access

Question 20

2 types of hemodialysis

Answer 20

acute & chronic (diff of 3 months)

Question 21

hemodialysis vs perioneal dialysis– which one?

Blood is filtered using an extracorporeal circuit and artificial membrane

Answer 21

hemodialysis

Question 22

hemodialysis or peritoneal dialysis– which one

Blood is filtered using native intra abdominal vessels and peritoneal membrane; Must be done every night

Answer 22

peritoneal dialysis

Question 23

3 dialysis related complication

Answer 23

• hypovolemia
• alkalemia
• hypotension: ultrafiltration > plasma refill

Question 24

4 access related dialysis complication

Answer 24

• nonfunction, infections
• steal syndrome (AVF> AVG)
• high output heart failure (AVF)
• central venous stenosis (catheters)

Question 25

what is the condition

all blood goes to vein causing gangrene; need to check blood flow in digits & treated by decreasing blood inside fistula

Answer 25

steal syndrome (AVF > AVG)

Question 26

blood is coming back to heart right away without going to other vessels straining the heart

Answer 26

high output heart failure (AVF)

Question 27

what replacement therapy has these benefits?

• Relatively unrestricted diet
• Freedom to travel
• Fertility restoration
• Return to employment
• Lifestyle free of dialysis constraints
• cost effective

Answer 27

transplant

Question 28

what replacement therapy? what are 3 cons to it?

• better lifestyle, mental satisfaction & economics
• maintains renal function & less cardiac effects
• patient controls it
• preferred to start with

Answer 28

peritoneal dialysis
cons: peritonitis, membrane failure, uncontrolled diabetes

Question 29

what replacement therapy has these benefits? 4 cons to this method?

• better volume control; predictable performance
• used only 3x/wk
• no issues w/ blood sugar control

Answer 29

hemodialysis
cons: lifestyle restrains, access infections, loss of residual renal fx, cardiac stunning

Question 30

which replacement tx has higher mortality than lung cancer after 5 years?

Answer 30

hemodialysis

Question 31

these are signs of what

Tenderness or pain over the kidney transplant; general achy feeling
peripheral swelling
elevated temp, increase in BP or Cr
rapid weight gain.
decrease in urine output

Answer 31

acute rejection in kidney transplant