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CVPR > CVPR Week 8: CKD > Flashcards

CVPR Week 8: CKD Flashcards

1
Q

Objectives

A
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2
Q

How to measure kidney function and assess kidney damage

A

EGFR and Albuminuria

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3
Q

What do EGFR and Albuminuria tell you?

A

Kidney function and assessment of kidney damage

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4
Q

EGFR AKA

A

Estimated glomerular filtration rate

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5
Q

Test of renal damage

A

protein in the urine (albuminuria)

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6
Q

Test of renal function

A

EGFR

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7
Q

How to calculate EGFR

A
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8
Q

GFR vs eGFR

A
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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
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10
Q

Examples of medications that interfere with the measurement of serum creatinine

A
  • Trimethoprim
  • vitamin D analogs
  • Tenofovir
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11
Q

Different eGFR estimating equations

A
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12
Q

What is Cystatin-C?

A

a novel measure of renal function

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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

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14
Q

Describe the physiologic basis of proteinuria/albuminuria

A
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15
Q

How is CKD screened for?

A
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16
Q

Normal to mildly increased albuminuria: 24-hour excretion

A

<30 mg/day

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17
Q

Normal to mildly increased albuminuria: timed urine specimen

A

<20 ug/min

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18
Q

Normal to mildly increased albuminuria: spot urine albumin/creatinine ratio (ADA)

A

< 30 mg/g

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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)

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20
Q

Moderately increased albuminuria: Spot urine albumin/creatinine ratio (gender specific) (K/DOQI)

A

17-250 (men)

25-355 (women)

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21
Q

Moderately increased albuminuria: Spot urine albumin/creatinine ratio (ADA)

A

20-300 mg/g

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22
Q

Moderately increased albuminuria: Spot urine albumin-specific dipstick (screening)

A

>3 mg/dL

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23
Q

Moderately increased albuminuria: Timed urine specimen

A

20-200 ug/min

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24
Q

Moderately increased albuminuria: 24-hour excretion

A

30-300 mg/day

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25
Q

Severely increased albuminuria: Spot urine albumin-specific dipstick (screening)

A

N/A

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26
Q

Severely increased albuminuria: Spot urine albumin/creatinine ratio (ADA)

A

>300 mg/g

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27
Q

Severely increased albuminuria: Timed urine specimen

A

>200 ug/min

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28
Q

Severely increased “macro-albuminuria” spot urine albumin/creatinine ratio (gender specific) (K/DOQI)

A

>250 (men)

>355 (women)

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29
Q

Dipstick urine tests

A
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30
Q

Urine protein/creatinine ratio test uses

A

All proteins, not albumin (myeloma/CIN)

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31
Q

UACR AKA

A

Urine albumin-to-creatinine ratio

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32
Q

Urine albumin-to-creatinine ratio (UACR) test uses

A
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33
Q

Which urine test is best?

A

ACR > PCR > Auto strip > Manual strip

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34
Q

How is urinary ACR not perfect

A
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35
Q

Urinary ACR and transient elevation in albuminuria

A
  • menstrual blood contamination
  • symptomatic UTI
  • Exercise
  • upright posture (orthostatic proteinuria)
  • Other conditions increasing vascular permeability
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36
Q

Urinary ACR and intraindividual variability in creatinine excretion

A
  • intrinsic biological variability
  • genetic variability
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37
Q

Urinary ACR and preanalytical storage conditions

A

degradation of albumin before analysis

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38
Q

Urinary ACR and non-renal causes of variability in creatinine excretion

A
  • 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)
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39
Q

Changes in creatinine excretion

A

Non-steady state for creatinine (AKI)

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40
Q

Urinary ACR and antigen excess

A

Samples with very high albumin concentrations may be falsely reported as low or normal using some assays

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41
Q

Prozone effect

A

Samples with very high albumin concentrations may be falsely reported as low or normal using some assays

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42
Q

What is the definition of CKD?

A
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43
Q

What is the level of kidney function required for CKD

44
Q

What is the level of kidney damage associated with kidney damage

45
Q

Explain the difference between CKD vs kidney failure vs ESRD vs uremia

46
Q

% of US population by % eGFR and Albuminuria

47
Q

Bad clinical outcomes for patients with CKD

48
Q

ESRD AKA

A

End-stage renal disease

49
Q

Leading causes of ESRD

50
Q

Risk factors for CKD

51
Q

Main functions of the kidneys

A
  • Homeostasis
  • hormone function
  • metabolic function
52
Q

Homeostatic functions of the kidney

A
  • filtration
  • reabsorption
  • secretion
53
Q

Hormone functions of the kidney

A
  • Renin
  • Erythropoietin
  • Calcitriol
54
Q

Metabolic functions of the kidney

A
  • Gluconeogenesis
  • Metabolize drugs and endogenous substances
55
Q

Physiological basis of clinical manifestations of CKD

56
Q

Mechanisms of adaptation to CKD

A
  • Intact nephron hypothesis (more work per nephron)
  • Osmotic diuresis
  • Functional reserve
  • Hyperinflation
  • Trade-off hypothesis
57
Q

Uremia GI symptoms

A
  • Nausea
  • vomiting
  • diarrhea
58
Q

Uremia CVS symptoms

A
  • Dyspnea
  • edema
  • chest pain
59
Q

Uremia and neuro symptoms

A
  • Restless legs
  • twitching
  • confusion
60
Q

Uremia Skin symptoms

A
  • Pruritus
  • bruising
  • uremic frost
61
Q

Uremia MSK symptoms

A
  • Bone pain
  • arthritis
62
Q

Signs and symptoms of the later stages of uremia

8 listed

63
Q

Common clinical manifestations of sodium balance in all stages of CKD

A
  • Weight gain
  • Peripheral edema
  • Pulmonary edema
64
Q

Uncommon clinical manifestations of sodium balance in all stages of CKD

A
  • Renal Na wasting (ECF volume depletion)
  • weight loss
  • systemic hypotension
65
Q

CKD primary care treatment

66
Q

ACEi or ARB for CKD

67
Q

Common medications used for treating CKD and hyperkalemia

A
  • ACEi
  • ARB

However need to check potassuium for ACEi and ARB within 7-10 days

68
Q

Medications used cautiously for treating CKD and hyperkalemia

A
  • Aldosterone antagonists
  • Renin inhibitors
  • K-sparring diuretics
  • NSAIDS

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
Q

Management of hyperkalemia

6 listed

70
Q

CKD and diabetes: Renal threshold for glucose

A

180-200 mg/dL

71
Q

CKD and diabetes: crosslinking

A

Sugars cross-linking to proteins changes their shapes and functions

72
Q

CKD and diabetes: A1C goal

A

individualized but <= 7% by ADA

73
Q

CKD and diabetes: spontaneous control of glycemic control

A

spontaneous improvement of glycemic control may indicate CKD progression

74
Q

CKD and diabetes: Risk for hypoglycemia

A

insulin is cleared from the kidneys and 20% of gluconeogenesis occurs in the kidney

75
Q

CKD and diabetes: risk of hyperkalemia

A

risk occurs with ACEi and ARBs as well as the closely monitored medications

76
Q

Use low-potassium juice to treat?

A

hypoglycemia

77
Q

Light-colored soda pop is lower in?

A

phosphorus than cola

78
Q

Interventions for reducing urine albumin

79
Q

Drug dosing considerations in CKD

A
  • 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
Q

Indications for referral to specialist kidney services

81
Q

Question 1

82
Q

Describe the cardiovascular complications in diabetic kidney disease

83
Q

Question 2

84
Q

Methods Improving outcomes in diabetes

4 listed

85
Q

Question 3

86
Q

Use of ACE and treatment of HTN does what in CKD?

87
Q

Question 4

88
Q

Reversible decreases in renal function in CKD

89
Q

Question 5

90
Q

CVD risk in CKD

91
Q

ESRD patients risk for CVD

92
Q

Risk factors for CVD in CKD

93
Q

Question 6

94
Q

Vascular calcification in CKD

95
Q

Types of vascular calcification

A
  • Intimal calcification
  • Medial calcification
96
Q

Describe intimal calcification

A

leads to plaques or circumferentially calcified atherosclerosis

97
Q

Describe medial calcification

A

is nonocclusive and leads to vascular stiffening and LVH

98
Q

How is the CAC score obtained and used

A

Electron beam computed tomography to determine the vascular calcification burden

99
Q

Other methods besides CT to acquire evidence of vascular calcification

A
  • duplex ultrasonography
  • echocardiography
  • pulse wave velocity
  • plain radiographs
100
Q

What % of HD patients have coronary artery calcification?

101
Q

When does extraskeletal calcifcation start in CKD?

A

Early and is highly prevalent

102
Q

good correlation between electron beam CT and what in quantifying vascular calcification

A

abdominal aortic radiographs

103
Q

Extraskeletal calcifications

104
Q

Describe the pathogenesis of calcification

105
Q

Question 7

106
Q

Kidney function and eGFR with age

107
Q

Question 8

CVPR (93 decks)

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