CKD Progression/Treatments

Question 1

Major Initiation Factors CKD (6+)

Answer 1

1. ) Diabetes Mellitus
2. ) Hypertension
3. ) Smoking
4. ) Obesity
5. ) Hyperlipidemia
6. ) Glomulonephritis

Others….

Question 2

Nephritic Kidney Disease

Answer 2

Inflammation of Nephron
S/Sx:
*hematuria
*proteinuria (1-3g QD)

Question 3

NephROTic Kidney Disease

Answer 3

S/Sx:
PROTEIN (>3.5g QD)
Edema
Hyperlipidemia
Hypercoagulable State

Question 4

Glomulonephritis (GN): Tx (4)

Answer 4

1. ) Corticosteroids
2. ) Cyclophosphamide (infection control)
3. ) Cyclosporine
4. ) Mycophenolate

Question 5

BP Goals: A1

Answer 5

ACR:

Question 6

BP Goals: A2

Answer 6

ACR: 30-300mg/g
GOAL:

Question 7

BP Goals: A3

Answer 7

ACR: >300mg/g
GOAL:

Question 8

Medication Induced HTN (8)

Answer 8

1. ) NSAIDs
2. ) Corticosteroids
3. ) Calcineurin Inhibitors
4. ) Sympathomimetics
5. ) ESAs (erythropoiesis-stim. agents)
6. ) Oral contraceptives
7. ) Illicit drugs
8. ) Herbals/supplements

Question 9

CKD: TZDs

Answer 9

GFR > 30mL/min * 1.73m^-2 only

• Offers CV protection
• Used to enhance fluid removal with loop diuretics

i.e. HCTZ

Question 10

CKD: Loops

Answer 10

FLUID MANAGEMENT

• high doses reserved for late stage (4+5)
• Hyperkalemia (risk)

Question 11

Potassium Lowering HTN Meds (2)

Answer 11

1. ) TZDs

2. ) Loops

Question 12

Potassium Raising HTN Meds (3)

Answer 12

1. ) Aldosterone Receptor Antagonist (ARA)
2. ) ACEis
3. ) ARBs

Question 13

Non-DHP CCBs

Answer 13

1. ) Verapamil
2. ) Diltiazem

No change in potassium levels

Question 14

Aldosterone Receptor Antagonists

Answer 14

ARAs

1. ) Spironolactone
2. ) Eplerenone

Hyperkalemia risk

Question 15

Direct Renin Inhibitors

Answer 15

DRIs
1.) Aliskiren (Tekturna(R))

**Avoid combination with ACEi or ARB

Question 16

ACEi + ARB Combination: Problem

Answer 16

Decreases proteinuria but INCREASES CKD progression

Question 17

ACE: Contraindication (4)

Answer 17

1. ) Hx angioedema (AAs)
2. ) Pregnancy
3. ) ACE-cough
4. ) Hypersensitivity rxn (ACE/ARB)

Question 18

ARB: Contraindications (3)

Answer 18

1. ) Hypersensitivity rxn (ACE/ARB)
2. ) Pregnancy
3. ) ARB-cough

Question 19

ACE: Caution (3)

Answer 19

1. ) Women w/o contraception
2. ) Bilateral renal artery stenosis
3. ) Hyperkalemia meds (i.e. Klor-Con, triamterene)

Question 20

ARB: Caution (4)

Answer 20

1. ) Hx angioedema (AAs)
2. ) Bilateral renal artery stenosis
3. ) Hyperkalemia meds (i.e. Klor-Con, triamterene)
4. ) 1.) Hx angioedema (AAs)

Question 21

ACE/ARB: Monitoring (eGFR)

Answer 21

Using SrCr (mL/min *1.73m^-2)
≥60mL/min –> repeat q4-12w
30-59mL/min –> repeat q2-4w
repeat q1-2w

Question 22

eGFR Reductions + Dose Adjustments: ACE/ARB

Answer 22

Reductions

• ≤15% –> no dose change + no additional monitoring
• 15-30% –> no dose change, repeat eGFR 10-14d
• 30-50% –> reduce dose; repeat q5-7d until 30% from baseline
• ≥50% –> stop dose; repeat q5-7d until 15% from baseline

Question 23

Monitoring Serum Potassium: ACE/ARB

Answer 23

Same monitoring regimen with eGFR
K+
> 5mM –> recommend diet change
> 6mM –> diet change + loop diuretic or resin