CKD Part I

Question 1

What is the GFR in a fully working kidneys?

Answer 1

200 ml/minute

Question 2

What is the definition of CKD?

Answer 2

1. kidney damage > or equal to 3 months, as defined by structural or functional abnormalities of the kidney, with/without reduced GFR manifested by either:
   a. pathological abnml; or
   b. markers of kidney damage, which is abnormal urine or imaging studies
2. GFR < 60 ml/min. for greater or equal to 3 months with or without kidney damage

Question 3

why do we look at proteinuria or albuminuria in the urine?

Answer 3

Presence indicates a poor prognosis

Question 4

How do people with CKD present?

Answer 4

No symptoms until eGFR less than 30 ml/min

• elevated serum creatinine
• microscopic or gross hematuria
• proteinuria (foamy urine)
• abnormal imaging study (incidential finding)

Question 5

How do you work up CKD?

Answer 5

Follow the same path as for AKI,

but time course determines whether it is acute or chronic

Question 6

How do you reduce hyperfiltration in the kidney?

Answer 6

Low protein diet

aldosterone antagonists or ACE-I/ARBs

Question 7

What is the definition of metabolic acidosis?

Answer 7

Lowered serum bicarbonate and low pH

Bicarb less than 24

pH less than 7.35

Question 8

What is a consequence of prolonged metabolic acidosis?

Answer 8

osteopenia or osteoporosis

Question 9

What are the conditions for dialysis?

AEIOU

Answer 9

acid/base disturbance

electrolyte abnormalities

remove posions (intoxication)

volume overload

uremia (creatinine clearance < 15 ml/mn)