CKD - Epi, Path, and Progression

Question 1

What’s the (arbitrary) time cutoff for “chronic” kidney disease?

Answer 1

3 months

Question 2

3 things to be done when a patient has ESRD (or as this lecture calls it, ESKD)?

Answer 2

Hemodialysis
Peritoneal dialysis
Kidney transplant
(more on these soon)

Question 3

Common glomerular pathology associated with CKD?

Answer 3

Glomerulosclerosis

Question 4

Common interstitial pathology associated with CKD?

Answer 4

Tubular atrophy and interstitial fibrosis.

Question 5

3 kidney things (2 aspects of function, 1… measurable thing) that decline/get worse with age?

Answer 5

GFR (important for drug dosing)
Vascular Auto-regulation
Kidney size/mass

Question 6

What’s the deal with error in estimates of GFR?

What does this have to do with 60 ml/min/1.73m^2 being the cutoff for CKD?

Answer 6

There’s less error at lower GFR, more error at higher GFR.

60 is an arbitrary cutoff below which you can be pretty confident that the actual GFR is that low.

Question 7

By far, the leading cause of ESRD is…

Answer 7

Diabetes Mellitus
then HTN (though it can be hard to separate out the two)

Question 8

Racial disparities in ESRD?

Answer 8

ESRD has the greatest in African Americans, then Native Americans, then others.

Question 9

Yearly mortality rate for ESRD with dialysis?

Answer 9

18%

Question 10

ESRD kills many people, damages quality of life, and costs the health care system over $20billion/yr.

Answer 10

Yeah.

Question 11

Lower eGFR -> more CVD events and hospitalization.

Proteinuria’s bad, too.

Answer 11

right