CVPR Week 8: CKD Flashcards
1
Q
Objectives
A
2
Q
How to measure kidney function and assess kidney damage
A
EGFR and Albuminuria
3
Q
What do EGFR and Albuminuria tell you?
A
Kidney function and assessment of kidney damage
4
Q
EGFR AKA
A
Estimated glomerular filtration rate
5
Q
Test of renal damage
A
protein in the urine (albuminuria)
6
Q
Test of renal function
A
EGFR
7
Q
How to calculate EGFR
A
8
Q
GFR vs eGFR
A
9
Q
When not to use creatinine-based estimates of kidney function
A
- in AKI when creatinine levels can be rapidly changing
- extremes of muscle mass, body size or altered diet patterns
- medications that interfere with the measurement of serum creatinine
10
Q
Examples of medications that interfere with the measurement of serum creatinine
A
- Trimethoprim
- vitamin D analogs
- Tenofovir
11
Q
Different eGFR estimating equations
A
12
Q
What is Cystatin-C?
A
a novel measure of renal function
13
Q
Cystatin-C vs Creatinine
A
estimating equations have been developed to use Cys-C alone or with SCr but creatinine and Cys-C don’t always agree
14
Q
Describe the physiologic basis of proteinuria/albuminuria
A
15
Q
How is CKD screened for?
A
16
Q
Normal to mildly increased albuminuria: 24-hour excretion
A
<30 mg/day
17
Q
Normal to mildly increased albuminuria: timed urine specimen
A
<20 ug/min
18
Q
Normal to mildly increased albuminuria: spot urine albumin/creatinine ratio (ADA)
A
< 30 mg/g
19
Q
Normal to mildly increased albuminuria: Spot urine albumin/creatinine ratio (gender specific) (K/DOQI)
A
<17 mg/g (men)
<25 mg/g (women)
20
Q
Moderately increased albuminuria: Spot urine albumin/creatinine ratio (gender specific) (K/DOQI)
A
17-250 (men)
25-355 (women)
21
Q
Moderately increased albuminuria: Spot urine albumin/creatinine ratio (ADA)
A
20-300 mg/g
22
Q
Moderately increased albuminuria: Spot urine albumin-specific dipstick (screening)
A
>3 mg/dL
23
Q
Moderately increased albuminuria: Timed urine specimen
A
20-200 ug/min
24
Q
Moderately increased albuminuria: 24-hour excretion
A
30-300 mg/day
25
Severely increased albuminuria: Spot urine albumin-specific dipstick (screening)
N/A
26
Severely increased albuminuria: Spot urine albumin/creatinine ratio (ADA)
\>300 mg/g
27
Severely increased albuminuria: Timed urine specimen
\>200 ug/min
28
Severely increased "macro-albuminuria" spot urine albumin/creatinine ratio (gender specific) (K/DOQI)
\>250 (men)
\>355 (women)
29
Dipstick urine tests
30
Urine protein/creatinine ratio test uses
All proteins, not albumin (myeloma/CIN)
31
UACR AKA
Urine albumin-to-creatinine ratio
32
Urine albumin-to-creatinine ratio (UACR) test uses
33
Which urine test is best?
ACR \> PCR \> Auto strip \> Manual strip
34
How is urinary ACR not perfect
35
Urinary ACR and transient elevation in albuminuria
* menstrual blood contamination
* symptomatic UTI
* Exercise
* upright posture (orthostatic proteinuria)
* Other conditions increasing vascular permeability
36
Urinary ACR and intraindividual variability in creatinine excretion
* intrinsic biological variability
* genetic variability
37
Urinary ACR and preanalytical storage conditions
degradation of albumin before analysis
38
Urinary ACR and non-renal causes of variability in creatinine excretion
* Age (lower in children and older people)
* Race (lower in caucasian than black people)
* Muscle mass (lower in people with amputations, paraplegia and muscular dystrophy)
* gender (lower in women)
39
Changes in creatinine excretion
Non-steady state for creatinine (AKI)
40
Urinary ACR and antigen excess
Samples with very high albumin concentrations may be falsely reported as low or normal using some assays
41
Prozone effect
Samples with very high albumin concentrations may be falsely reported as low or normal using some assays
42
What is the definition of CKD?
43
What is the level of kidney function required for CKD
44
What is the level of kidney damage associated with kidney damage
45
Explain the difference between CKD vs kidney failure vs ESRD vs uremia
46
% of US population by % eGFR and Albuminuria
47
Bad clinical outcomes for patients with CKD
48
ESRD AKA
End-stage renal disease
49
Leading causes of ESRD
50
Risk factors for CKD
51
Main functions of the kidneys
* Homeostasis
* hormone function
* metabolic function
52
Homeostatic functions of the kidney
* filtration
* reabsorption
* secretion
53
Hormone functions of the kidney
* Renin
* Erythropoietin
* Calcitriol
54
Metabolic functions of the kidney
* Gluconeogenesis
* Metabolize drugs and endogenous substances
55
Physiological basis of clinical manifestations of CKD
56
Mechanisms of adaptation to CKD
* Intact nephron hypothesis (more work per nephron)
* Osmotic diuresis
* Functional reserve
* Hyperinflation
* Trade-off hypothesis
57
Uremia GI symptoms
* Nausea
* vomiting
* diarrhea
58
Uremia CVS symptoms
* Dyspnea
* edema
* chest pain
59
Uremia and neuro symptoms
* Restless legs
* twitching
* confusion
60
Uremia Skin symptoms
* Pruritus
* bruising
* uremic frost
61
Uremia MSK symptoms
* Bone pain
* arthritis
62
Signs and symptoms of the later stages of uremia
8 listed
63
Common clinical manifestations of sodium balance in all stages of CKD
* Weight gain
* Peripheral edema
* Pulmonary edema
64
Uncommon clinical manifestations of sodium balance in all stages of CKD
* Renal Na wasting (ECF volume depletion)
* weight loss
* systemic hypotension
65
CKD primary care treatment
66
ACEi or ARB for CKD
*
67
Common medications used for treating CKD and hyperkalemia
* ACEi
* ARB
However need to check potassuium for ACEi and ARB within 7-10 days
68
Medications used cautiously for treating CKD and hyperkalemia
* Aldosterone antagonists
* Renin inhibitors
* K-sparring diuretics
* NSAIDS
## Footnote
**For Aldosterone antagonists and direct renin inhibitors need to check potassium within 7-10 days**
**In CKD or diabetes need to check potassium within 3-7 days with K-sparing diuretics**
69
Management of hyperkalemia
6 listed
70
CKD and diabetes: Renal threshold for glucose
180-200 mg/dL
71
CKD and diabetes: crosslinking
Sugars cross-linking to proteins changes their shapes and functions
72
CKD and diabetes: A1C goal
individualized but \<= 7% by ADA
73
CKD and diabetes: spontaneous control of glycemic control
spontaneous improvement of glycemic control may indicate CKD progression
74
CKD and diabetes: Risk for hypoglycemia
insulin is cleared from the kidneys and 20% of gluconeogenesis occurs in the kidney
75
CKD and diabetes: risk of hyperkalemia
risk occurs with ACEi and ARBs as well as the closely monitored medications
76
Use low-potassium juice to treat?
hypoglycemia
77
Light-colored soda pop is lower in?
phosphorus than cola
78
Interventions for reducing urine albumin
RARARAI
79
Drug dosing considerations in CKD
* Risk for adverse reactions increases due to impaired renal function AND comorbidities
* Doses of many common drugs have to be adjusted or the drugs stopped (Diabetes agents/MEtformin/SGLT2/Insulin) also (CNS acting agents) and (anticoagulants) and (Antibiotics)
* MOST DRUGS HAVE NEVER BEEN TESTED IN CKD PATIENTS
80
Indications for referral to specialist kidney services
81
Question 1
82
Describe the cardiovascular complications in diabetic kidney disease
83
Question 2
84
Methods Improving outcomes in diabetes
4 listed
85
Question 3
86
Use of ACE and treatment of HTN does what in CKD?
87
Question 4
88
Reversible decreases in renal function in CKD
89
Question 5
90
CVD risk in CKD
91
ESRD patients risk for CVD
92
Risk factors for CVD in CKD
93
Question 6
94
Vascular calcification in CKD
95
Types of vascular calcification
* Intimal calcification
* Medial calcification
96
Describe intimal calcification
leads to plaques or circumferentially calcified atherosclerosis
97
Describe medial calcification
is nonocclusive and leads to vascular stiffening and LVH
98
How is the CAC score obtained and used
Electron beam computed tomography to determine the vascular calcification burden
99
Other methods besides CT to acquire evidence of vascular calcification
* duplex ultrasonography
* echocardiography
* pulse wave velocity
* plain radiographs
100
What % of HD patients have coronary artery calcification?
50%
101
When does extraskeletal calcifcation start in CKD?
Early and is highly prevalent
102
good correlation between electron beam CT and what in quantifying vascular calcification
abdominal aortic radiographs
103
Extraskeletal calcifications
104
Describe the pathogenesis of calcification
105
Question 7
106
Kidney function and eGFR with age
107
Question 8
