General Flashcards
What is the definition of CKD?
abnormal kidney structure or function for >3 months
What is the diagnostic eGFR for CKD?
eGFR of < 60 mL/min per 1.73m2 which are persistent (present for ≥ 3 months) are diagnostic of CKD
What are considered at-risk groups for CKD?
• Diabetes
• Hypertension
• Cardiovascular disease (CVD)
• Prior acute kidney injury (AKI)
• Family history of kidney disease (e.g., parent or sibling)
• Specific high-risk ethnic groups: Indigenous peoples,
Pacific Islanders, African Asian, and South Asian descent
eGFR is reliant on steady state of ________
Unreliable in…..
Steady state of creatinine generation
Unreliable if extreme muscle mass, very high or low protein diet, hospitalized or AKI
urine ACR
what is considered an abnormal value?
uACR >3.0 mg/mmol
urine ACR
if pt does not have diabetes and has isolated uACR between 3-30, what is the next step?
If NO DIABETES: isolated uACR between 3-30 does not require specific treatment but should have surveillance (at risk of CKD and CVD)
urine ACR is unreliable in these situations
Unreliable if acute illness, vigorous exercise, poorly controlled HTN or DM
At-risk populations for CKD should be screened with….?
At-risk populations should be screened every 1–2 years
depending upon clinical circumstances (e.g., annually
for individuals with diabetes) using:
- eGFR
- urinalysis (dipstick)* (micro not needed)
- urine ACR
- review of risk factors
URGENT REFERRAL to nephro in these situations
• Presence of active urine sediments (red blood cell casts or cellular casts ± protein), especially when associated with
reduced eGFR.
• AKI in absence of readily reversible cause (e.g., volume depletion, NSAIDs)
• Abrupt sustained fall in eGFR in a patient with known CKD.
• eGFR < 15
• Nephrotic syndrome
TIMELY REFERRAL to nephro in patient with diabetes and eGFR < _____ and urine ACR > ______
Diabetes and evidence of CKD with eGFR <45, urine ACR >30
What are the two most common causes of CKD?
HTN
DM
what are potential complications of CKD?
-AKI
-anemia
-HTN
-decreased calcium absorption
-drug toxicity
-CVS: dyslipidemia, HF, volume overload, LVH
-electrolytes: hyperkalemia, hyperphosphatemia, hyperuricemia
-hyperparathyroidism
metabolic acidosis
Definition of AKI?
increase in creatinine by >26 umol/L or 1.5 x baseline
consider holding which medications to prevent AKI in situations such as receiving contrast dye, acute illness with dehydration, or surgery
- ACE-I or ARB
- SGLT-2
- diuretics
When should Cr and K be checked after starting or increasing dose of ACE-I, ARB, SGLT2i, MRA?
within 7-14 days of starting or dose increase
*Cr rise >20% after dose increase should be rechecked in 7-14 days
