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Bloc D - Renal > Jan18 M2-Chronic Kidney Disease > Flashcards

Jan18 M2-Chronic Kidney Disease Flashcards

1
Q

2 common CKD dx and how to distinguish them

A

glomerulosclerosis
diabetic nephropathy
(distinguish with proteinuria)

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2
Q

2 urine protein tests to check

A

microalbumin

urine protein/Cr

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3
Q

what microalbumin in urine test tells us

A

endothelium health
less 1.9 = healthy
more 1.9 = might not be healthy

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4
Q

what urine protein/Cr ratio tells us (if convert it to g/day)

A

less 1g=some prot and tubules can’t reabsorb it bc too much but prob not in tubules
1-3g = non dx
more 3g = glomerular

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5
Q

less 1g protein a day points to what etiology for the CKD

A

glomerulosclerosis (same as ischemic sclerosis or hypertensive nephropathy)

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6
Q

how does U protein guide us for biopsy

A

less 1g a day: no biopsy
1-3g + bad GFR + hematuria = biopsy
more 3g a day = biopsy (except diabetic)

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7
Q

hypertensive glomerulosclerosis pathophgy

A

htn alters the endoth cells. ats and scarring follow, capillaries collapse

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8
Q

how to differentiate a diabetic nephropathy from a glomerulosclerosis

A

diabetes has its own clinical presentation

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9
Q

5 chronological steps in diabetic nephropathy

A
  1. microalbuminuria
  2. albuminuria (1g, 2g, ..)
  3. 3g+/day nephrotic proteinuria
  4. rise in Cr
  5. renal failure
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10
Q

special charact on histo for diabetic nephropathy (if ever you would do a biopsy)

A

Kimmelstiel Wilson lesions (nodular sclerosis)

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11
Q

number 1 cause for needing dialysis in the world

A

diabetic nephropathy

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12
Q

type 1 diabetes vs type 2 diabetes: how diabetic nephropathy differs and why

A

type 1 is worse. more KW lesions and more end up needing dialysis. something goes wrong on genetic level

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13
Q

how is proteinuria related to Cr in diabetic nephropathy

A

once you reach the 3g mark, Cr starts to rise a lot

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14
Q

how can you check if it’s a diabetic nephropathy with protein and Cr values

A

check if they correspond. if big rise in Cr but didn’t go over the 3g threshold, it’s not diabetic nephropathy

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15
Q

glomerulosclerosis: things to be careful about (4)

A
  • volume depletion
  • nephrotoxins
  • no NSAIDs
  • dose meds
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16
Q

glomerulosclerosis vs diabetic nephropathy prognosis

A

prognosis of diabetic nephropathy is much worse

GS has good prognosis

17
Q

3 examples of chronic glomerulonephritis diseases and which has worst prognosis

A
  • IgA nephropathy, -FSGS (worst)

- membranous nephropathy

18
Q

ADPKD how does it change with time

A

higher risk of dialysis as age increases

19
Q

most important thing to control in CKD and why

A

htn. accelerates the loss of renal fct. affects proteinuria

20
Q

how to control htn in CKD + what it also helps for

A

ACEi. also helps for the proteinuria

21
Q

how BP affects Cr

A

if proteinuria 1g+ a day, higher BP = risk to double Cr

less 1g a day = no link

22
Q

how long between onset of DM and microalbuminuria

A

10 yrs

23
Q

pathophgy of diabetes

A

glycoproteins insert in the BM and BM damage occurs (really when microalbuminuria starts)

24
Q

how to reverse proteinuria in diabetic patients

A

control BP below 120/75 and give ACEi/ARB

25
Q

BP goal in uncomplicated htn

A

less 140/90

26
Q

BP goal in CKD with proteinuria +1g a day

A

less 130/80

27
Q

BP goal in diabetic with albuminuria

A

less 130/80

28
Q

6 pillars of CKD (things that the kidney normally checks but that we have to check below GFR of 30)

A 
Anemia
Increased K
Acidosis
Bone disease (Ca/PO4/PTH)
Volume overload
HTN
29
Q

Anemia, why happens in CKD and how to treat it + target

A
  • not enough EPO made
  • give ESA (erythrocyte stimulating agents)
    target: 100-120 Hb
30
Q

how to avoid hyperK in CKD

A

low diet K
kayexelate
avoid K increasing meds

31
Q

why acidosis happens in CKD

A

kidney can’t generate bicarb

32
Q

why secondary PTH happens in CKD

A 
no calcitriol, high PO4 (bc less excreted). 
low Ca (bc PO4 sequesters it) + low calcitriol stimulate PTH
33
Q

management of hyperPTH non pharma and pharma

A

low PO4 diet
binders: sevelamer, lanthanum, CaCO3 (this will also raise Ca)
vit D when PO4 controlled
cinacalcet (occupies CaSR on PT)

34
Q

how to control volume overload in CKD and what to be careful about

A

fluid resitrction, furosemide. be careful about pre-renal AKI

35
Q

how to control htn in CKD

A

ACEi. reach the targets

36
Q

how to plan for dialysis

A

fistula placement in the arm, at least 8 weeks before dialysis

37
Q

criteria for starting dialysis

A

GFR and how patient feels** (loss of appetite, nausea/vomiting, feeling unwell, trouble concentrating: uremic symptoms)

38
Q

when to refer to a nephrologist in CKD (5 scenarios possible)

A
  • CrCl of 30 or less (GFR less 30)
  • U prot 2-3 g/day
  • 5% risk at 5 years
  • U Alb/Cr 100
  • hematuria + any renal insufficiency
39
Q

how to prevent AKI in CKD

A

prevent volume contraction.

NO NSAIDs if they’re on ACEi/ARB

Bloc D - Renal (32 decks)

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