Clinical features/management CKD Flashcards
CKD Definition
- Kidney damage for >/= 3 months as defined by structural/functional abnormalities with or without DEC GFR manifested by either pathologic abnormalities or markers of kidney damage
- GFR < 60 ml/min/1.73 m^2 for >/= 3 months
COCKCROFT-GUALT EQUATION
GRR = (140-age)(Wt)/72(SCr)
*X0.85 for females
Low MW protein used for GFR
Cystatin C
Mechanisms of CKD progression
- Hemodynamic: Loss of renal mass -> Hyperfiltration -> Glomerular HTN
- Abnormal permeability macromolecules: Hyperfiltration -> excessice p[rotein filtration/cap leak (mediated by RAAS) -> glomerularsclerosis, proteinuria, + fibrosis
\ - GF: RAAS, AGEs, + other pro-inflammatory mediators result in fibrosis
Most important risk factors for progression of CKD
- Proteinuria
- HTN
- Extent of TI Dx
- Poor glycemic control
- AKI
Goal BP CKD Patients
Proteinuria: 130/80
Nonproteinuira: 140/90
Choice anti-hypertensives for CKD
ACis or ARBs in proteinuric patients; Not clear for nonproteinuric
Most common reason for resistance
to erythropoiesis therapy
INC Fe reqs -> Fe deficiency
CKD + VitD + PTH
Kidney converts VitD to active form -> Ca/PO4 reabsoprtion + PTH suppression
CKD -> Hypovitaminosis D -> Hyperphosphatemia, Hyperparathyroidism, + HypoCalcemia
Treatment CKD-a/s vitamin/mineral def
- Phoisphate Binders
- Calcitriol + analogues
CKD Acidosis + Tx
- Acidosis occurs when GFR < 60
- Tx Bicarb till > 22 meq/l
Lipid goals CKD
TG < 500
LDL < 100
Hormones that accumulate in Renal failure
- ACTH
- Gastrin
- Insulin
- PTH
- ETC
GFR when to initiate dialysis nondiabetic vs diabetic
- Diabetic 15 ml/min
- Non 10 mil/min
What is the blood flow that must be provided in a dialysis care?
200-500 ml/min
