CKD (Selby)

Question 1

<3mo with <60 GFR

Answer 1

is AKI

Question 2

CKD definition

Answer 2

either a marker of kidney damage (one of more) or decreased GFR for >3 months

Question 3

markers of kidney damage

Answer 3

albuminuria

urine sediment abnormalities

electrolyte/other abnormalities due to tubular disorder

abnormalities detected by histology

structural abnormalities detected by imaging

Hx of transplant

Question 4

CKD as defined by GFR

Answer 4

<60 mL/min for >3 months

Question 5

CKD stage 1

Answer 5

> 90

normal or high

Question 6

CKD stage 2

Answer 6

60-89

mild decrease

Question 7

CKD stage 3a

Answer 7

45-59

mild to moderate decrease

Question 8

CKD stage 3b

Answer 8

30-44

moderate to severe decrease

Question 9

CKD stage 4

Answer 9

15-29

severe decrease

Question 10

CKD stage 5

Answer 10

<15

kidney failure/ESRD

Question 11

in absence of evidence of kidney damage stage 1 or 2

Answer 11

is NOT enough to fulfill criteria for CKD

Question 12

what causes CKD the most

Answer 12

diabetes

Question 13

what is the second most common cause of CKD

Answer 13

HTN

Question 14

what is the third most common cause of CKD

Answer 14

glomerulonephritis

Question 15

diabetes and HTN together make up what percent of CKD

Answer 15

64%

Question 16

clinical presentation of CKD

Answer 16

is dependent on severity

many patients are asymptomatic and are found from routine testing

Question 17

signs and symptoms of CKD

Answer 17

Edema
HTN
oliguria
Foamy urine
Uremia
Pericardial friction rub
asterixis
Uremic frost

Question 18

what is asterixis

Answer 18

tremor of the hand while arm is extended

Question 19

Serum creatinine

Answer 19

poor marker of kidney function

Question 20

eGFR

Answer 20

estimated GFR based on a few different formulas and is not accurate in setting of rapidly changing creatinine

Question 21

measured GFR

Answer 21

most accurate method but only performed in some institutions

Question 22

creatinine clearance

Answer 22

tends to overestimate GFR

Question 23

proteinuria

Answer 23

urine albumin to creatinine ration or urine protein to creatinine ratio

Question 24

diagnosis of CKD

Answer 24

serum creatinine
GFR
Creatinine clearance 
Proteinuria 
Urinalysis with microscopy
Renal Biopsy

Question 25

diagnosis of CKD imagining

Answer 25

renal US Doppler Renal US abdominal CT scan Abdominal MRI scan

Question 26

renal US findings for CKD

Answer 26

atrophic or small kidneys cortical thinnings increased echogenicity elevated resistive indices

Question 27

3 simple tests to identify most CKD

Answer 27

eGFR urine albumin to creatinine ratio urinalysis

Question 28

RI ==

Answer 28

(peak systolic flow -lowest diastolic flow)/peak systolic flow

Question 29

RAR

Answer 29

PSVrenal/PSVaorta

Question 30

renal US

Answer 30

can evaluate size of kidney/cortical thickness/echogenicity/presence of hydronephrosis/renal mass/cysts

Question 31

doppler renal US

Answer 31

evaluate for renal artery stenosis (RAS) or renal vein thrombosis or resistive index

Question 32

abdominal CT scan

Answer 32

better at detecting masses and kidney stones can evaluate for the same things as renal US

Question 33

abdominal MRI

Answer 33

can evaluate for renal artery stenosis renal vein thrombosis renal masses

Question 34

treatment of CKD complication: proteinuria

Answer 34

low Na diet BP control ACEi/ARB/aldosterone /renin inhibitor

Question 35

treatment of CKD complication: HTN goal pressure

Answer 35

if no proteinuria goal 140/90 if proteinuria goal 130/80

Question 36

treatment of CKD complication: hyperlipidemia

Answer 36

statins

Question 37

treatment of CKD complication: anemia

Answer 37

oral or IV iron EPO stimulating agent (ISA)

Question 38

treatment of CKD complication: metabolic acidosis

Answer 38

HCO3 supplement if HCO3 < 22

Question 39

treatment of CKD complication: hyperkalemia

Answer 39

renal failure diet (low Na/K/Phos) diuretics sodium polystyrene sulfonate

Question 40

treatment of CKD complication: CKD-BMD

Answer 40

``` secondary hyperPTH renal failure diet phosphorus binder Vit D supplement Calcimimetics (lower PTH) dialysis ```

Question 41

treatment of CKD complication: volume overload

Answer 41

diuretics fluid restriction dialysis

Question 42

dialysis indication

Answer 42

``` AEIOU Acidosis (severe) ``` Electrolyte disturbance (usually hyperkalemia) Ingestion (ethylene glycol) Overload (volume) Uremia

Question 43

RRT (renal replacement therapy)

Answer 43

hemodialysis peritoneal dialysis renal transplant