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PHA 415 - Therapeutics III > Exam 2 - Chronic Kidney Disase > Flashcards

Exam 2 - Chronic Kidney Disase Flashcards

1
Q

What are the 2 most predominant conditions leading to the progression of CKD?

A

1) DM

2) HTN

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2
Q

Name 4 conditions associated with CKD.

A

1) DM
2) HTN
3) Glomerulonephritis
4) Polycystic kidney disease

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3
Q

Describe the pathophysiology of CKD.

A
  • Progressive nephropathies have a final common pathway to irreversible parenchymal damage
  • -1) Loss of nephron mass
  • -2) Glomerular capillary HTN
  • -3) Proteinuria
  • Progressive loss of structural nephron units
  • Ultimate loss of kidney function
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4
Q

What enzyme does the kidney release into the blood?

A

RENIN

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5
Q

What timeline and qualifications is required for CKD?

A

Presence of:

  • Markers of kidney damage (1 or more)
  • Decreased GFR

Either present for >3 months

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6
Q

Name the markers of kidney damage.

A
  • Albuminuria (AER >30 mg/24h or ACR >30 mg/g)
  • Urine sediment abnormalities
  • Electrolyte and other abnormalities due to tubular disorders
  • Abnormalities detected by histology
  • Structural abnormalities detected by imaging
  • Hx of kidney transplantation
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7
Q

What GFR level meets the criteria for CKD after >3 months?

A

<60 mL/min/1.73 m^2

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8
Q

How is CKD categorized (CGA)?

A

C - Cause
G - GFR category (G1-G5)
A - Albuminuria category (A1-A3)

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9
Q

What are the GFR categories?

A
  • G1 = >90
  • G2 = 60-89
  • G3a = 45-59
  • G3b = 30-44
  • G4 = 15-29
  • G5 = <15
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10
Q

Which stage of GFR categories has two parts (a and b)?

A

Stage G3

  • G3 a = 45-59
  • G3 b = 30-44
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11
Q

What are the albuminuria categories?

A
  • A1 = <30
  • A2 = 30-300
  • A3 = >300
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12
Q

Name the non-pharmacologic treatment for CKD progression.

A
  • Dietary protein restriction (0.8 g/kg/day for pts with GFR <30 mL/min)
  • Moderate intensity physical activity for total cumulative duration of 150 min/week or level compatible with CV and physical tolerance
  • If pt has HTN, low Na diet (<2 g/day)
  • Limit alcohol intake (No >2 standard drinks/day)
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13
Q

What is the protein restriction for pts with GFR <30 mL/min?

A

0.8 g/kg/day

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14
Q

Name the pharmacologic treatment for CKD progression.

A
  • Control of HTN (ACE-I/ARB)
  • Glycemic control (A1c <7%)
  • SGLT2 inhibitors
  • Statins
  • Smoking cessation
  • Weight management (goal BMI <20-25)
  • Treatment of anemia
  • Treatment of CK-MBD
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15
Q

What are the ADA recommendations for albumin:Scr sceenings?

A

ANNUAL

  • For T1DM = 5 years after dx
  • For T2DM = after dx
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16
Q

Name the minimum frequency of monitoring for GFR/Albuminuria per categories.

A
  • Low Risk = 1 x/year = A1, G1-G2
  • Moderately Increased Risk = 1 x/year = A1-A2, G1-G3a
  • High Risk = 2 x/year = A1-1A3, G1-G3b
  • Very High Risk = 3-4 x/year = A1-A3, G3a-G5
17
Q

What is the BP goal?

A

<130/80 mmHg

18
Q

What is the NEW target BP for HTN and CKD according to KDIGO?

A

<120/80

19
Q

Name the treatment for CKD pts that have HTN.

A

ACE-I

ARBs

20
Q

T/F: ACE and ARBs are renoprotective.

A

TRUE

21
Q

What does SGLT2 and SGLT1 do in terms of glucose reabsorption?

A
  • SGLT2 = reabsorption of 90% filtered glucose

- SGLT1 = reabsorption of 10% filtered glucose

22
Q

Name the FDA approved SGLT2 Inhibitor.

A

DAPAGLIFLOZIN (Farxiga)

23
Q

What is the brand name of Dapagliflozin?

A

Farxiga

24
Q

What is the drug class of Farxiga?

A

SGLT2 Inhibitor

25
Q

What is the drug class of Dapagliflozin?

A

SGLT2 Inhibitor

26
Q

T/F: Farxiga reduces eGFR decline.

A

TRUE

27
Q

When do you discontinue Metformin and SGLT2 Inhibitors in CKD?

A
  • eGFR<30

- dialysis

28
Q

T/F: SGLT2 Inhibitors have no role in kidney-heart risk factor management.

A

FALSE AS SHIT

-SGLT2 Inhibitors do have a role in kidney-heart risk factor management

29
Q

What is the eGFR range that is a high-risk condition for CKD pts to have a very high risk of future ASCVD events?

A

eGFR 15-59 mL/min

30
Q

T/F: You continue statin therapy if CKD-HD pts were already on the statin.

A

TRUE

31
Q

Who do not get a statin if they were not already on a statin in terms of HD treatment?

A

CKD-HD pts that were not already on a statin do not receive statin therapy

PHA 415 - Therapeutics III (17 decks)

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