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Nephrology Fellowship Reviewer > CPGS > Flashcards

CPGS Flashcards

2021 Exam CPGs: DM, Lepto, KT and Donor

1
Q

Start of monitoring of Ca, phosphate, PTH, Alkphos

A

CKD G3a

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2
Q

interval of monitoring of Ca and Phos

A

G3: q6-12
G4 q3-6
G5 Q1-3

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3
Q

PTH interval monitoring

A

G3 baseline
G4: q6-12 months
G5 - q3-6 months

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4
Q

gold standard for the diagnosis and classification of renal osteodystrophy

A

bone biopsy

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5
Q

when to do bone biopsy

A

unexplained fractures, refractory hypercalcemia, suspicion of osteomalacia, atypical response to standard therapies for elevated PTH, progressive decreases in BMD despite standard therapy

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6
Q

dialysate calcium should be

A

1.25-1.50 mmol/L

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7
Q

PTH should be maintained in

A

2-9x of upper normal limit for the assay

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8
Q

severe hyperparathyroidism failing to respond to medical

A

parathyroidectomy

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9
Q

immediate post KT Ca and phos monitoring

A

weekly until stable

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10
Q

when to reduce dose or discontinue ACEi/ARBs

A

symptomatic hypotension or uncontrolled hyperkalemia

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11
Q

Physical activity for DM

A

moderate intensity for at least 150 mins per week

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12
Q

First line therapy for Type 2 DM and CKD

A

Metformin and SGLT2

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13
Q

Weight loss, HF, high risk ASCVD
(Dm meds effect)

A

GL1P-RA

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14
Q

Potent glucose lowering drug
(2)

A

GL1P-RA, insulin

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15
Q

avoid hypoglycemia
(4 drug)

A

GL1P
DPP4
TZD
AGI

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16
Q

Low cost

A

SU, TZD, aGI

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17
Q

EGFR < 15 or with HD

A

DPP4, insulin TZD

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18
Q

When to adjust dose of Metformin

A

EGFR < 45-59

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19
Q

evaluation for KT should be done

A

at least 6-12 months before anticipated dialysis

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20
Q

when to not recommend transplant

A

multiple myeloma unless curative tx and in remission;
AL amyloidosis with extrarenal involvement, decompensated cirrhosis; severe irreversible lung disease; uncorrectable and symptomatic cardiac disease; central neurodegenerative disease

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21
Q

Delay transplant evaluation until properly managed

A

unstable psych, substance disorder, ongoing health compromising nonadherent behavior, active infection, malignancy, cardiac disease, peripheral arterial disease; recent stroke, gi disease, hepatitis; severe hpt

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22
Q

exception of infection that may proceed with transplant evaluation

A

hepatitis C

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23
Q

exception in malignancies that can proceed with transplantation

A

low grade - prostate cancer (gleason score < 6) and renal tumors (<1 cm)

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24
Q

pre-emptive transplantation with a living kidney donor as preferred treatment for transplant eligible CKD patients who

A

eGFR < 10 ml/min or earlier with symptoms; EgFR < 15 ml/min for children

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25
Q

abstain from tobacco use at a minimum of ___ prior to waitlisting or living donor

A

1 month

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26
Q

screening for current or former heavy tobacco smokers (>= 30 pack years)

A

chest CT scan

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27
Q

antiplatelets except aspirin should be stopped ____ days prior to living donor transplantation

A

5 days

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28
Q

contraindication to transplant in terms of anticoagulation

A

on direct acting oral anticoagulants (apixaban, rivaroxaban)

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29
Q

management for symptomatic PCKD (pain, infection, malignancy, insufficient room for transplant)

A

staged or simultaneous native nephrectomy

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30
Q

primary hyperoxaluria type 1

A

combined or sequential liver-kidney transplantation

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31
Q

strategies to lower total body oxalate burden

A

intensive dialysis

diet modification and pyridoxine treatment

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32
Q

HCV and compensated cirrhosis (without portal hypertension)

A

isolated kidney transplantation

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33
Q

HCV and decompensated cirrhosis

A

combined liver-kidney transplantation and deferring HCV treatment until after transplantation

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34
Q

monitoring of hbsag and hbv dna post transplant for hbsag negative, anti-hbc positive patients for

A

min of 1 year

35
Q

vaccination for varicella and MMR for seronegative candidates should be done

A

at least 4 weeks prior to transplantation

36
Q

live vaccines

A

MMR, VZV, shingles, yellow fever, oral typhoid, polio

37
Q

splenectomized patients

A

pneumococcal, hemophilus and meningococcal vaccination

38
Q

screening for bladder cancer

A

high level cyclophosphamide, heavy smoking of 30 pack years

39
Q

screening for bladder ca

A

cystoscopy

40
Q

screening for hcc

A

ultrasound, a-fetoprotein

41
Q

no waiting time for candidates with surgically curatively treated

A 
nonmetastatic basal cell ca
melanoma in situ 
small renal cell Ca < 3 cm 
prostate Ca gleason score < 6 
carcinoma in situ (ductal, cervical) 
thyroid ca, follicular, papillarry < 3 cm superficial bladder cancer
42
Q

acute leukemia and high grade lymphoma

A

avoid transplant unless curative and remission and cancer free

43
Q

noninvasive CAD screening

A

asymptomatic candidates at high risk for CAD (DM, previous CAD) with poor functional capacity

44
Q

asymptomatic advanced triple vessel coronary disease

A

excluded

45
Q

asymptomatic candidates on dialysis for at least 2 years, risk factors for pulmonary hypertension

A

2d echo

46
Q

cut off for pulmonary artery systolic pressure

A

> 45 or > 60 (R heart catheterization)

47
Q

exclude from transplant

A

uncorrectable CLass 3/4, severe CAD, EF < 30%, severe valvular disease

48
Q

cardiac amyloidosis

A

exclude

49
Q

clinically apparent PAD + abnormal noninvasive testing or prior vascular procedure

A

noncontrast CT imaging of the abdomen/pelvis

50
Q

at least ____ after a stroke or after a TIA before a KT

A

6 months after stroke

3 months after TIA

51
Q

screen candidates with ADPKD disease for

A

intracranial aneurysms (high risk)

52
Q

if symptoms suggestive of PUD

A

EGD and Hpylori testing

53
Q

acute pancreatitis, should delay KT

A

minimum of 3 months after symptoms have resolved

54
Q

major complications of leptospiroris, marker of severity and indication for hospitalization

A

AKI (poorer prognosis)

55
Q

Features of leptospirosis associated AKI

A

sterile pyuria, tea colored urine, mild proteinuria to severe anuric acute renal failure, nonoliguric renal failure with mild hypokalemia, oliguria with hyperkalemia (severity of AKI)

56
Q

oliguria with hyperkalemia

A

poor prognosis

57
Q

pathology of leptospirosis associated AKI

A

acute tubular damage and tubulointerstitial nephritis

58
Q

lab findings associated with increase ind eath

A

neutrophilia and thrombocytopenia

59
Q

predictors of mortality in severe leptospirosis

A

crea > 3, age > 40, oliguria, platelet < 70k and pulmonary involvement

60
Q

Tubular dysfunction

A

hyponatremia and hypokalemia

61
Q

responsible for non-oliguria

A

vasopressin resistance

62
Q

urine output < 0.5 ml/kg/hr or M 400 ml/day or report decrease or no urine output with the last 12 hours

A

oligura

63
Q

predictors of oliguria

A

> 40 years, crackles, low arterial pH, hyponatremia, increased crea, elevated DB and AST, low platelet and low alkphos

64
Q

recommended map in leptospirosis

A

65-70 mmhg

65
Q

initial fluid resuscitation in shock

A

ballanced crystalloids

66
Q

If K is in the high normal value or with hyperkalemia

A

isotonic saline

67
Q

initial rate

A

20 ml/kg.hr or 500 ml within 15-30 minutes

68
Q

indications for acute rrt

A

uremic symptoms; pH <7.2, fluid overload, oliguria despite adequate hydration, crea > 3, K > 5 in an oliguric patient, ARDS, pulmo hemorrhage

69
Q

frequency of dialysis in leptospirosis

A

daily dialysis

70
Q

hemodynamically unstable dialysis modality

A

CRRT

71
Q

indications for pulse therapy

A

AKI plus one of the ff: platelet < 100k, MAP < 65, inotropes, ards, prolonged PT/PTT

72
Q

dose of pulse therapy

A

3 doses of MPPT 500 mg+ 1 dose of cyclophosphamide 60 mk IV

73
Q

Donors should stop smoking

A

at least 4 weeks before donation and life long abstinence

74
Q

evaluation of GFR

A

serum creatinine

75
Q

confirmation of GFR

A

measured GFR using inulin
measured CrCl
eGFR using crea and cystatin C
repeated estimated GFR from serum crea

76
Q

acceptable GFR

A

> 90 ml/min

77
Q

GFR that should not donate

A

GFR < 60 ml/min

78
Q

acceptable AER

A

< 30 mg/day

79
Q

AER that should not donate

A

> 100 mg/day

80
Q

IgA nephropathy

A

do not donate

81
Q

evaluation for persistent microscopic hematuria

A

urinalysis and urine CS; cystoscopy and imaging, 24h urine stone panel, kidney biopsy

82
Q

elevated FBS, gestational DM or family history of DM in a first degree relative

A

2h OGTT or Hba1c

83
Q

repeat testing of HIV, HBC and HCV

A

within 28 days

84
Q

Genetic kidney disease that can cause kidney failure and APKD; pregnant

A

do not donate

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