Clinical Reasoning-Chronic Kidney Disease Flashcards
What defines chronic kidney disease?
3 months or greater symptoms of eGFR < 60, albuminuria > 30mg, abnormal urine sedimentation or abnormal imaging.
What defines end stage renal disease
eGFR <15
What are the different definitions of the different stages of chronic kidney disease?
*
What age group has the highest likelihood of having chronic kidney disease?
60
What are the most common causes of end-stage renal disease?
This is likely due to people with chronic conditions living long enough to see chronic kidney disease.
At what stages of kidney disease do you see manifestations of hypertension, bone/mineral disease, anemia, acidosis/hyperkalemia and uremia?
*
How do you manage patients with CKD due to hypertension?
Decrease dietary sodium and put them on diuretics.
Why are patients with CKD at higher risk for fractures and vascular calcification?
CKD impairs PO4- excretion and conversion of vitamin D to 1,25 active form. This stimulates PTH, causing secondary hyperparathyroidism and high-turnover of bone…weakening bone and increasing risk for fractures.
Why has the transfusion rate for patients with CKD gone down over the past 20 years?
Development of recombinant erythropoietin formulas given subcutaneously when Hbg levels < 9g/dL have decreased the amount of patients who get anemic.
Why might you consider putting a patient with CKD on oral bicarbonate supplementation?
CKD can impair the ability to excrete ammonium, leading to normal anion-gap metabolic acidosis. Giving oral bicarbonate would be an attempt to make the blood more basic.
What is the most common medical emergency you see in patients with CKD?
Hyperkalemia is associated with sudden cardiac death.
What population is at risk for early hyperkalemia due to CKD?
Diabetics. They develop early hypoaldosteronism, which decreases K+ excretion at the distal tubule.
What medications may put your patient with CKD at risk for hyperkalemia?
ACE-I and aldosterone antagonists.
What is uremia?
Elevation of multiple organic nitrogenous compounds, can be estimated by BUN.
In what ways does uremia manifest itself in the CNS, CV system, bone, endocrine and constitutionally?
*
A patient comes to your clinic complaining of fatigue. Lab analysis reveals a decreased hematocrit, proteinuria and elevated BUN. His eGFR is low. You diagnose the patient with stage 1 chronic kidney disease. What factors would put this patient at risk for disease progression to end-stage renal failure?
PKD1 (polycystic kidney disease gene), APOL1 (AA ethnicity specific), diabetes, hypertension, proteinuria and drugs (especially NSAIDs).
What causes accelerated dropout of functioning nephrons once a kidney has been initially injured?
The nephrons make up for the initial loss in function by hyper filtration. This causes hypertrophy, endothelial insult and eventual fibrosis and loss of function in the originally healthy nephrons.
