Kidney Disease

Question 1

What is microalbuminuria

Answer 1

30-300 mg/g

too small to show up in dipstick

shows early damage to kidney - time to treat! Delay or stop progression of damage

Question 2

What is proteinuria?

Answer 2

300-1000mg of Albumin

dipstick will turn positive

Protein to Cr ratio will be 1-2

Question 3

What does 4+ proteinuria indicate?

Answer 3

nephrotic!

Question 4

What causes transient proteinuria?

Answer 4

exercise, fever, postural proteinuria, dehydration, cold exposure, stress

Question 5

Criteria for nephrotic syndrome

Answer 5

• Al/Cr range >4
• Edema
• Decreased serum albumin
• Reflexive hyperlipidemia

Question 6

What are the major classifications of nephrotic syndrome?

Answer 6

Diabetes, Lupus, Drugs, Infections

HTN does not cause nephrotic syndrome

Question 7

Stages of CKD

Answer 7

• 1 – protein in urine, normal GFR >90
• 2 – protein in urine GFR 60-89
• 3a – GFR 45-59
• 3b – GFR 30-44
• 4 – GFR 15-29
• 5 – FGR

must persist >3mo

Question 8

CKD and salt

Answer 8

• for BP control, almost always need salt restriction: 2 g/day

Question 9

CKD and protein

Answer 9

• Protein:
  
  • St 1-2: no restriction
  • St 3-4: restrict
    
    • high protein also –> high salt, aci precursors, phosphates. Can lead to metabolic acidosis, hyperkalemia, hyperphospathemia, edema, HTN, uremic sx
    • Recommended: 0.8 g protein/kg of ideal body weight (actual wt may be d/t edema or obesity)
      
      • if uremic sx persist - 0.6g/kg/day

Question 10

CKD and caloric intake

Answer 10

St 3-4: <30kcal/kg of ideal body wt

Question 11

Medication assessment for CKD patient should include

Answer 11

At every visit:

• Dosage adjustment based on level of kidney function;
• Detection of potentially adverse effects on kidney function or complications of chronic kidney disease;
• Detection of drug interactions;
• Therapeutic drug monitoring, if possible.

(KDOQI)

Question 12

What is the

Classification of Kidney Disease Outcome Quality Initiative?

Answer 12

through the NKF

This program provides evidence-based guidelines for all stages of chronic kidney disease (CKD) and related complications

Question 13

Patients with GFR <60 mL/min/1.73 m2 should be evaluated and treated for complications of decreased GFR. This includes measurement of:

Answer 13

• Anemia (hemoglobin);
• Nutritional status (dietary energy and protein intake, weight, serum albumin, serum total cholesterol);
• Bone disease (parathyroid hormone, calcium, phosphorus);
• Functioning and well-being (questionnaires).

(KDOQI)

Question 14

Estimated GFR should be monitored yearly in patients with chronic kidney disease, and more frequently in patients with:

Answer 14

• GFR <60 mL/min/1.73 m2
• Fast GFR decline in the past ( 4 mL/min/1.73 m2)
• Risk factors for faster progression
• Ongoing treatment to slow progression
• Exposure to risk factors for acute GFR decline.

(KDOQI)

Question 15

What to watch out for with DM and CKD

Answer 15

Individuals with diabetic kidney disease are at higher risk of diabetic complications, including retinopathy, cardiovascular disease, and neuropathy.

They should be evaluated and managed according to established guidelines.

Question 16

Individuals at increased risk for CKD should be tested at the time of a health evaluations to determine if they have CKD. These include individuals with:

Answer 16

• Diabetes;
• Hypertension;
• Autoimmune diseases;
• Systemic infections;
• Exposure to drugs or procedures associated with acute decline in kidney function;
• Recovery from acute kidney failure;
• Age >60 years;
• Family history of kidney disease;
• Reduced kidney mass (includes kidney donors and transplant recipients).

(KDOQI)

Question 17

Measurements used to determine presence of CKD

Answer 17

• Serum creatinine for estimation of GFR *primary parameter
• Assessment of proteinuria;
• Urinary sediment or urine dipstick for red blood cells and white blood cells.

(KDOQI)

Question 18

When should preparation for kidney replacement therapy (dialysis and transplantation), as well as vascular access care, be initiated?

Answer 18

when the estimated GFR declines to <30 mL/min/1.73 m2.

(KDOQI)

Question 19

Treatments to slow progression of ckd in adults

Answer 19

• ACE/ARB
• Strict glycemic control (if diabetic)
• Strict BP control
• Dietary protein restriction? (inconclusive evidence)

(KDOQI)