Clinical Skills-Diabetic Nephropathy Flashcards
Why shouldn’t you base your diagnosis of chronic kidney disease solely on eGFR?
The eGFR only has an 80% chance of being within 30% of the patient’s actual GFR?
What is the best laboratory value to use when assessing a patient for chronic kidney disease?
UACR (Urine albumin-to-creatinine ratio). The “normal” cutoff is 30mg albumin:1g creatinine. This translates to 30mg albumin per day.
What is defined as microalbuminuria?
30mg/g - 300mg/g that is not detected by dipstick test.
How does diabetes damage the kidney?
Lots of glucose is reabsorbed with lots of Na+. Patients are volume inflated. This causes hyper filtration and hypertrophy of the glomerulus.
What can you do to slow the progression of chronic kidney disease?
Manage hypertension (< 140/90 w/ARBs or ACEi), control diabetes (A1C < 7%), lower urine albumin and decrease CVD risk factors.
How do ARBs and ACE-Is reduce the progression of chronic kidney disease beyond lowering blood pressure?
Dilating the efferent arteriole reduces the glomerular pressure and causes less filtration of serum albumin.
How can you tell from a patient’s blood work if the ACE-I or ARB you prescribed is benefiting their kidney?
Serum creatinine will go up because the pressure in the glomerulus has gone down and filtration has decreased.
What is the only good thing that comes to patients with diabetic nephropathy?
Insulin is metabolized by the kidney. Decreased insulin metabolism means it lasts longer and that people’s blood sugars go down.
If hyperglycemia harms the kidney, why don’t we implement intensive glucose control therapy in all patients?
The risk of becoming hypoglycemic outweighs the benefit of a decrease in albuminuria
Why might body builders see accelerated progression of chronic kidney disease?
Animal protein is rich in N, P, K and metabolic acids that need to be filtered by the kidney. This increases GFR and renal blood flow which can damage the kidney.
You see a patient with a decrease eGFR and albuminuria. What can you do to decrease renal events (death, dialysis or half eGFR)?
Give an ARB or ACE-I, reduce Na+ intake, control diabetes early, lose weight, reduce protein intake and quit smoking to decrease albuminuria.
What is the leading cause of morbidity and mortality in patients with chronic kidney disease?
Cardiovascular disease
How would a patient with chronic kidney disease benefit from taking a statin?
CKD causes increased levels of cholesterol and triglycerides in the blood. Decreasing those levels will decrease incidence of CVD.
What percentage of people who have lost more than half of their kidney function actually know that they have renal disease?
20.00%
What can the primary care provider do to delay the need for renal replacement therapy?
Monitor eGFR & UACR. Screen for anemia (Hgb), malnutrition (albumin) and metabolic bone disease. Treat CVD. Nutritional and educational guidance.
