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MJ- F2 E5- Renal > CKD- SG > Flashcards

CKD- SG Flashcards

1
Q

Duration of CKD?***

A

3 months

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2
Q

The combination of CKD and ____ significantly raise the risk of CVD and death.

A

diabetes

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3
Q

What treatment of patients with ESRD/CKD is a major cause of morbidity and mortality?

A

dialysis

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4
Q

What is a common cause of death in pts w/ ESRD?

A

Cardiovascular Disease

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5
Q

What is the life expectancy of age group 40-44 y/o w/ ESRD?

A

8 years

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6
Q

Which 2 conditions are the major causes of CKD?

A

DM & HTN

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7
Q

Kidney disease for greater than _____ as evidenced by structural or functional abnormalities with or without decreased GFR.

A

3 months

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8
Q

CKD is the presence of GFR < ___ for ___ months with or without other signs of kidney damage.

A

60

3 months

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9
Q

1 abnormality of CKD?

A

Albuminuria

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10
Q

**Stage 5 CKD is a GFR < ___ and the patient is on dialysis (ESRD)***

ON EXAM

A

<15

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11
Q

In which stage of Albuminuria should you intervene early to slow progression of CKD?

A

A2 & A3

(moderately & severely increased)

(3 mg/mmol or more)

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12
Q

What medication is shown to decrease progression in early stages?

A

ACE inhibitors

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13
Q

What measurement is now included w/ GFR measurements?

A

Albuminuria

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14
Q
  • Pts w/ CKD are usually asymptomatic until GFR is < ___.
  • What sxs would they have?
A
  • 15
  • Mental foginess, N/V
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15
Q

In which 5 people would you screen for CKD?

A
    • fam hx
  • HTN
  • DM
  • >60 y/o
  • Ethnic minorities (Northern Africa, Latin America, Native Americans)
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16
Q

3 complications of CKD

A
  • Anemia
  • Coagulopathy
  • Pericarditis
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17
Q

uPRO/uCR ratio correlates to the expected grams of ____ in ___ hours.

A

protein / 24 hrs

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18
Q

4 components of a UA/ urine microscopy

A
  • Sediment analysis
  • RBCs / RBC casts (nephritic)
  • WBCs / WBC casts (infection)
  • Crystals for stones
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19
Q

What test is NOT usually helpful for evaluation of CKD?

A

24 hour urine

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20
Q

Eval/Labs of CKD

  • _____ is not affected by meds that affect the renal tubules
A

Cystatin C

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21
Q
  • What 3 labs will you order once disease has been determined?
  • What are 2 other things to look for?
A
  • Electrolytes (Na, K, Ca, Phos)
  • CBC
  • BUN
  • Hyperparathyroidism evaluation
  • Serum Protein Electrophoresis (SPEP)
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22
Q

US eval

  • _____ suggestive of chronic disease
  • ____ from obstruction
  • ____ and infiltrative cancers can cause enlargement
  • Disparity from _____
A
  • Atrophic kidneys
  • Hydronephrosis
  • Amyloidosis
  • ischemia
23
Q

The National Kidney Foundation recommends that every pt w/ GFR < ___ (stages __ & __), undergo a nephrology evaluation.

A

60 / 3 & 4

24
Q

What is the first step in treating CKD?

A

Prevention

  • Control hyperglycemia
  • Meet ACC/AHA guidelines for HTN (but don’t tx too aggressively)
  • Review meds
25
Q

What is the BP goal for pts w/ CKD?

A

140/80

26
Q

3 causes of Pre-renal

A
  • Hypotension
  • Hypovolemia
  • Medications
27
Q

3 causes of Intrarenal

A
  • Meds (Vanco, Aminoglycosides, NSAIDS)
  • IV contrast
  • Infection
28
Q

Cause of post-renal

A

Obstruction

29
Q

4 meds which can cause a false + rise in creatinine

(Interfere w/ creatinine secretion and assay)

A
  • Cimetidine
  • Trimethoprim
  • Cefoxitin
  • Flucytosine
30
Q

Progression often due to what 3 causes unrelated to the original disease

(cause scarring and further decline in kidney function)

A
  • Intra-glomerular HTN & hypertrophy
  • Metabolic acidosis
  • Tubulointersitial disease

(TIM)

31
Q

Slowing Progression of CKD

  • HTN management
  • DM management
  • Smoking cessation
  • Tx cholesterol
  • Renal vitamins (which 4?)
  • What type of diet?
A
  • K, Ca, P, Mg
  • Low protein diet and water
32
Q
  • ACE inhibitors or ARBs have greatest benefit when GFR is what value?
  • With or without proteinuria?
A

>60 (early on in disease)

33
Q
  • Can usually maintain fluid balance until GFR is __.
  • What is a good way to manage volume?
A
  • 15 mL/min
  • Na reduction
34
Q

In which 2 circumstances would you monitor potassium in pt?

A
  • Pts w/ oliguria
  • Pts on K sparing meds
35
Q

Which condition?

  • May play a rose in further disease progression
  • Can worsen bone disease
  • Can worsen cachexia
  • Sodium Bicarbonate for tx
A

Metabolic Acidosis

36
Q

Disorder in mineral metabolism

  • Hyperphosphatemia
  • Hypocalcemia
  • Low vit D

–> results in?

A

Secondary hyperparathyroidism

37
Q

Tx Complications of CKD

  • Mechanism differs based on degree of CKD
  • If untreated, secondary hyperparathyroidism & renal osteodystrophy occur
  • Dietary modifications important in early disease
  • Phosphate binders required once GFR is
A

Hyperphosphatemia

  • 25
38
Q

As GFR decreases, what happens to Phosphorus and Calcium?

A
  • Phosphorus increases
  • Calcium decreases
39
Q

Tx Complications of CKD

  • Common problem in CKD
  • Several manifestations
  • Vit D deficiency
  • KDOQI and KDIGO guidelines
A

Bone Disease

40
Q

Tx Complications of CKD

  • Typically _____ ______
  • Usually when GFR
  • Usually from reduction in erythropoietin (can give erythropoietin prior to dialysis)
  • Non-renal causes need to be evaluated
A
  • Normocytic normochromic
  • 60
41
Q

Tx Complications of CKD

  • ___ usually develops w/ GFR
  • Sxs:
    • N/V
    • Anorexia
    • Fatigue
    • Confusion
    • Platelet dysfunction
    • Pericarditis
    • Neuropathy
    • Sexual dysfunction
A

Uremia

42
Q

Values of GFR

  • Severely decreased (prep for transplant)
  • Kidney failure (transplant)
A
  • 15-29
  • <15
43
Q

Definition:

  • Diffusion of small molecules down their concentration gradient across a semi-permeable membrane
A

Dialysis

44
Q

5 Indications for EMERGENT dialysis

A
  • Acidosis (Severe Metabolic Acidosis)
  • Electrolyte disturbance (Severe hyperkalemia)
  • Intoxication (Overdose w/ dialyzable substance)
  • Overload (fluid overload unresponsive to diuretic therapy)
  • Uremia (BUN >100)

AEIOU

45
Q

5 indications for NON-emergent dialysis

A
  • HTN (medication resistant)
  • Uremia
  • Metabolic disturbance (chronic acidosis, hyperkalemia)
  • N/V - malnutrition
  • Fluid overload (diuretic resistant)

(HUMNF)

46
Q

Definition

  • Retention of nitrogen waste from kidney dysfunction
  • Pericarditis
  • Neurologic (Seizures, encephalopathy, Asterixis)
  • Coagulopathy
A

Uremia

  • Asterixis: tremor, jerking of hand, tongue and feet
47
Q

4 factors of diffusion of dialysis

A
  • Blood flow rate
  • Membrane surface area
  • Permeability of membrane
  • Time
48
Q

Definition:

Removal of water from patients circulation

A

Ultrafiltration

49
Q

What are the 3 types of Dialysis?

A
  • Standard dialysis (hemodialysis)
  • Peritoneal dialysis
  • Continuous renal replacement therapy (CRRT)
50
Q

5 complications of Standard Dialysis

A
  • Hypotension
  • Disequilibrium syndrome (HA, lethargy, nausea)
  • Dialyzer reactions (Type A - anaphylaxis)
  • Clotting / bleeding
  • Arrhythmias
51
Q

What type of dialysis?

  • Dialysate solution is introduced via catheter
  • Uremic toxins diffuse across capillaries
  • Water moves toward the hypertonic dialysate fluid following osmotic gradient
  • The “dirty” fluid is drained
A

Peritoneal Dialysis

  • Catheter is placed in peritoneal cavity
  • Uremic toxins diffuse across peritoneal capillaries across the peritoneal membrane into the peritoneum
52
Q
  • What are the 3 complications of Peritoneal Dialysis?
  • Which one is the major complication?**

(probably on exam)

A
  • PERITONITIS!! (most important)
  • Exit site infection
  • Poor dialysate drainage
53
Q

Renal Transplantation

  • Best option for renal replacement therapy (if no contraindications)
  • Mortality if 2.6X greater on dialysis
  • Mortality reduced by 68%
  • Wait list is growing
  • Median wait time?
A

2.6 years

MJ- F2 E5- Renal (13 decks)

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