Kidney Disease (CKD)

Question 1

Creatinine normal values

Answer 1

0.5-1.2

Question 2

BUN normal values

Answer 2

10-20

Question 3

GFR normal rate

Answer 3

> 90 ml/min

Question 4

Bun to Creatinine Ratio

Answer 4

10:1

Question 5

Chronic Kidney Disease: Definition

Answer 5

Presence of kidney damage for >3 months with or without a GFR of <60

An inability to:

1. Maintain acid-base balance
2. Remove end product of metabolism
3. Maintain fluid and electrolyte balance

Question 6

Causes of ESKD

Answer 6

1. Diabetes 50%
2. HTN 30%
3. Glomerulonephritis 10%
4. Other 10%

Question 7

Chronic Kidney Disease: risk factors

Answer 7

Family Hx
Age (Increased)
Male
African American
HTN, DM, Smoking
Obesity or overweight

Question 8

3 Key Characteristics of CKD

Answer 8

1. Glomerulosclerosis
2. Interstitial Fibrosis
   - destruction of renal tubules + capillaries
3. Interstitial Inflammation

Question 9

What plays a major role in the process of CKD

Answer 9

Complement 
Angiotensin II (Inc BP)

Question 10

Clinical manifestations of CKD (stages)

Answer 10

1. Asymptomatic
2. Asymptomatic, possible HTN
3. HTN, otherwise asymptomatic
4. Manifestations becoming apparent (diagnosis often occurs here)
5. ESRD “uremia”

Question 11

Uremia and its contents

Answer 11

Retention of many metabolic wastes

Urea
Creatinine
Phenols
Hormones
Electrolytes
Water

Question 12

When is Uremia often seen?

Answer 12

When GFR < or equal to 10 ml/min

Uremia: high levels of urea in blood

Question 13

Clinical Manifestations of End-Stage Renal Disease (ESRD/ESKD)

Answer 13

1. Can’t maintain F+E
   - Edema, hyperkalemia, hyperphosphatemia
2. Can’t rid body of wastes
   - Anorexia, malnutrition, itching, CNS changes
3. Decreased production of erythropoietin
   - Anemia
4. Decreased activation of Vitamin D
   - Renal Osteodystrophy

Question 14

High concentrations of metabolic waste can cause?

Answer 14

Itchy Skin “Uremic Frost”
ESRD

Uremia can also effect mood

Question 15

Drugs can be used to do what for CKD?

Answer 15

Slow rate of progression

• Reduce BP to <140/90
• Cholesterol <200

ACE or ARB (110-130 ideal)

Question 16

Complications of CKD that can be treated

Answer 16

Volume overload: Loop diuretic (w/low salt diet)

Hyperkalemia: Hemodialysis

Metabolic Acidosis: sodium bicarb

Hyperphosphatemia: calcium carbonate

Renal osteodystrophy: Calcitriol (vit D)

Anemia: erythropoietin

Question 17

CKD: Treating Metabolic Acidosis

Answer 17

Sodium Bicarbonate

• slow progression
• prevent bone loss
• Improve nutritional status

Question 18

CKD: guidelines for Bicarb administration

Answer 18

Initiate: plasma HCO3 <15 mEq/ml
(measured by serum or plasma CO2 on BMP)

Titrate to 18-20
-can switch to Sodium Citrate if bloating

Question 19

Treating Hyperphosphatemia

Answer 19

Calcium Carbonate (TUMS)
-binds phosphate

Goals: Keep phosphate levels normal
-reduce mortality

Take with meals so calcium can bind with phosphate in meals

AE: Hypercalcemia (monitor calcium)

Question 20

Treating Osteodystrophy

Answer 20

Calcitriol

MOA: activated vitamin D
-Stimulated absorption of calcium/phosphate and bone mineralization

AE: hypercalcemia, hyperphosphatemia

Question 21

Signs of Calcium toxicity

Answer 21

GI upset, Bone pain, neuro effects (sluggish), cardiac arrhythmias

Question 22

Drugs of concern with CKD

Answer 22

Digoxin
Diabetic agents (glyburide, metformin)
Antibiotics (vancomycin)
Opioids (morphine)

Renal dosing optional

Question 23

Stages of CKD with GRF Numbers

Answer 23

1. (≥90) Kidney damage with normal or increased GFR
2. (60-90) Kidney damage with mild decrease in GFR
3. (30-59) Moderate decrease in GFR
4. (15-29) Severe decrease in GFR
5. (<15) ESRD