CKD Pathophysiology and Progression

Question 1

What is the length of decline in kidney function should be present for classification of CKD?

Answer 1

3 months

Question 2

What are the two most common chronic disease states that contribute to CKD?

Answer 2

Diabetes

HTN

Question 3

According to the KDOQI guidelines, who are susceptible to CKD? Which disease states initiate CKD? Which factors contribute to an increase in the progression of the disease?

Answer 3

Susceptible

• Age > 60
• Non - caucasian
• Family history of diabetic neuropathy (diabetes)
• Low income

Initiation

• Diabetes
• HTN
• Glomerulonephritis

Progression

• Hyperglycemia
• HTN
• Hyperlipidemia
• High-protein diet
• Obesity
• Smoking
• Illicit Drug Use

Question 4

What is the criteria for CKD?

Answer 4

Either of the following present for >3 months

• markers of kidney damage (Alb:Creat > 30mg/g, electrolytes)
• decreased GFR (GFR < 60mL/min/1.73m2)

Question 5

In measuring GFR, should we use serum creatinine and cystatin C together or separately?

Answer 5

Together

Question 6

What are methods for detecting proteinuria?

Answer 6

Urine dipstick
24 hr urine collection
alb:creat ratio

Question 7

What are the categories of severity in alb:creat ratios?

Answer 7

Normal to mild - 300mg/g

Question 8

If a person has a GFR of 90, what would make that person classify as a stage 1 CKD patient?

Answer 8

Evidence of kidney damage

Question 9

What are the stage cutoffs of CKD in terms of GFR?

Answer 9

Stage 1    >90
Stage 2   60-89
Stage 3a   45-59
Stage 3b   30-44
Stage 4   15-29
Stage 5  <15

Question 10

What is the pathophysiology of Progressive CKD?

Answer 10

Nephron mass lost –> nephrons initially compensate and undergo hypertrophy

Later these get tired and the body increases intraglomelular blood pressure to ease it for the nephrons

Pores will stretch out and proteins will be able to leak through and proteins are not good in the tubules

Question 11

How does the body increase intraglomerular pressure?

Answer 11

Expand the afferent arteriole and constrict the efferent.

Question 12

What are the BP goals of CKD?

Answer 12

JNC VII : 130/80 or <125/75 if proteinuria
JNC VIII : 140/90
KDIGO: 130/80

Question 13

What are some other prevention strategies for CKD other than BP control?

Answer 13

Glucose control

• A1c >7%
• FBG 70 - 120mg/dL

Dietary protein restriction
- 0.6 g/kg/day

Lipid Control

• ATPIII LDL >100mg/dL, <70 if CVD present
• ACC/AHA 2013 high or mod. statin

Stop smoking and taking in so much salt and exercise

Question 14

Which HTN meds are good for CKD?

Answer 14

ACEi/ARBs

Expands efferent arterioles and protects kidneys by lowering intraglomerular pressure