Kidneys: Part 2 (paulson)

Question 1

Chronic Kidney Disease (CKD) is kidney damage or decreased kidney function for ___ months

Answer 1

≥ 3 months

Question 2

CKD:

-MC causes?

Answer 2

• Diabetes

- HTN

Question 3

Why we care about CKD?

Answer 3

• 59% of Americans develop CKD 3 or higher during life

- About 50% of those with CKD will have an occurrence of AKI

Question 4

___% of high risk patients with CKD are not identified

Answer 4

90%

–Leading cause of death in CKD patients

Question 5

CKD patients are at increased risk for ________ disease

Answer 5

Cardiovascular disease

–CV is the leading cause of death in CKD patients

Question 6

Risk Factors for CKD

Answer 6

>60 years old
HTN
Diabetes
CV disease
FH of CKD
Recurrent UTIs
Previous AKI
Nephrolithiasis
Transplant
Autoimmune Disease
Smoking

Question 7

Creatinine= a product of _____

Answer 7

muscle metabolism, excreted by kidneys

Question 8

Creatinine

-normal range?

Answer 8

0.6-1.2 mg/dl

Question 9

GFR=

Answer 9

Plasma filtration by glomerulus (aka creatinine clearance)

Question 10

Normal GFR

Answer 10

> 90 ml/min/1.73m2

Question 11

What is the gold standard for measuring GFR?

Answer 11

**insulin clearance

Question 12

Other methods of measuring GFR

Answer 12

MDRD and Cockcroft-Gault equations commonly used

Question 13

MDRD should not be used in Pts with _____

Answer 13

AKI

Question 14

Cockgroft equation requires:

Answer 14

Remember to use IBW in obese or fluid overloaded patients

Cockgroft requires gender, Age, weight, to calculate Creatinine clearance

Question 15

Proteinuria=

Answer 15

Refers to all types of proteins that might be in urine

Question 16

Normal level of protein in urine

Answer 16

<150 mg/d.

Question 17

Gold standard test for Proteinuria

Answer 17

** 24 hour urine –>Urine protein to creatinine ratio

Question 18

Proteinuria:

-etiology?

Answer 18

-Tubular damage, diabetic nephropathy, glomerulonephritis, rhabdo, Bence Jones proteins

Less concerning causes: exercise, orthostatic proteinuria, acute sickness

Question 19

Albuminuria is specific to ____

Answer 19

**CKD

Question 20

albuminuria is pathopneumonic for _____

Answer 20

kidney damage

Question 21

Albuminuria can be detected before changes in ______ function occur

Answer 21

renal

-**(detects early CKD)

Question 22

Albuminuria:

-what is the preferred screening test?

Answer 22

• Urine albumin to creatinine ratio preferred screening

- Yearly screening recommended

Question 23

Normal range of albumin in urine

Answer 23

Normal: <30 mg/d

Question 24

Moderately increased albuminuria (range?)

Answer 24

Moderately increased albuminuria: 30-300 mg/day

Question 25

Severely increased albuminuria (range?)

Answer 25

- >300 mg/day | - “Macroalbuminuria”

Question 26

Higher albuminuria is associated with quicker progression to _______

Answer 26

kidney failure

Question 27

Early detection of moderately and severely increased albuminuria in diabetics can be treated with ____ or ____ and decrease the amount of ________

Answer 27

- ACEI or ARB | - albuminuria

Question 28

Diabetics: Recommended target A1c is ___% to prevent or delay progression of microvascular complications of diabetes, including CKD

Answer 28

7.0% A1c of 7%= 150mg glucose

Question 29

CKD stage includes | both GFR and ______

Answer 29

albuminuria

Question 30

Classification of CKD using GFR and ACR categories

Answer 30

image slide 8

Question 31

Normal kidney is ___cm

Answer 31

10cm

Question 32

Shrunken kidney indicates _____

Answer 32

CKD

Question 33

Kidney size on US can help differentiate b/w ____ and _____ issues

Answer 33

acute and chronic kidney issues

Question 34

Medications to avoid/be aware of in CKD patients

Answer 34

``` NSAIDs Contrast Magnesium (common in laxatives) Phosphorous (Fleet’s enemas) Aluminum (Maalox, Rolaids) Antimicrobials Diabetic meds Decongestants Antihypertensives Opioids & gabapentin ```

Question 35

Remember to _______ _____ meds!!

Answer 35

Remember to renally dose meds!!

Question 36

Complications of CKD

Answer 36

- HTN - Hyperphosphatemia: - Hyperparathyroidism: Give Vitamin D - Anemia - Hyperkalemia - Acidosis - uremic encephalopathy

Question 37

Tx/management of hyperphosphatemia in CKD Pts

Answer 37

- Give phosphate binders (Sevelamer) | - Foods to avoid (dark soda, high protein foods)

Question 38

Tx/management of Anemia in CKD Pts | -what is the goal for Hgb?

Answer 38

- Erythropoietin, Aranesp(bone marrow stimulant), iron supplementation - Goal for Hgb: 10-11

Question 39

Tx/management of hyperkalemia in CKD Pts

Answer 39

Low potassium diet, Kayexelate, dialysis (If a pt misses dialysis once--> this can result in life threatening complications such as hyperkalemia --> give them a dose of Kayexelate to hold them over until next dialysis appointment

Question 40

Tx of Acidosis in CKD Pts

Answer 40

Sodium bicarb

Question 41

Dialysis is usually started around GFR of ____

Answer 41

10-15 | -**Or if unable to control volume status or hyperkalemia

Question 42

why do you have to "think ahead" when initiating dialysis in a Pt with CKD?

Answer 42

Arteriovenous fistula (AVF) needs about 2 months to mature

Question 43

Hemodialysis (HD) occurs __x a week

Answer 43

3x

Question 44

Peritoneal Dialysis (PD): - Continuous Ambulatory PD (CAPD)--> how often is tx required? - Continuous Cyclic PD (CCPD): how often?

Answer 44

Continuous Ambulatory PD (CAPD): 4-5x/day Continuous Cyclic PD (CCPD): Machine cycles at night while asleep PD (catheter is inserted into the abdomen)

Question 45

Urine Microscopy findings for CKD: | -if squamous epithelial cells are found, what does this indicate?

Answer 45

Sample probably contaminated Renal Tubular Cells/Casts: ATN or AIN RBC casts: Glomerulonephritis, AIN, vasculitis WBC casts: interstitial nephritis, pyelo, inflammation Fatty casts: nephrotic syndrome Hyaline casts: can be normal “Muddy brown casts” = ATN

Question 46

Urine Microscopy findings for CKD: | -Renal tubular cells/casts indicate ____

Answer 46

ATN or AIN

Question 47

Urine Microscopy findings for CKD: | -RBC casts indicate _____

Answer 47

**Glomerulonephritis, AIN, vasculitis

Question 48

Urine Microscopy findings for CKD: | WBC casts indicate ____

Answer 48

interstitial nephritis, pyelonephritis, inflammation

Question 49

Urine Microscopy findings for CKD: | -Fatty casts indicate ______

Answer 49

nephrotic syndrome

Question 50

Urine Microscopy findings for CKD: | -Hyaline casts indicate _____

Answer 50

can be normal

Question 51

Urine Microscopy findings for CKD: | -“Muddy brown casts" indicate _____

Answer 51

**ATN muddy brown=granular casts

Question 52

Nephrotic Syndrome: - Sx? - Lab findings (on UA)? - Lab findings on CBC

Answer 52

- **Edema - **Proteinuria (**foamy urine) - **Low serum albumin - **Hyperlipidemia

Question 53

Nephrotic Syndrome: | -causes?

Answer 53

- Diabetes - Minimal change disease - FSGS (Focal segmental glomerular sclerosis) - Membranous nephropathy

Question 54

Nephritic Syndrome: | -3 classic findings?

Answer 54

- **Hypertension - **Hematuria - *Proteinuria (less than nephrotic syndrome)

Question 55

Nephritic Syndrome: | -causes?

Answer 55

- Post-infectious glomerulonephritis - IgA nephropathy - Membranoproliferative glomerulonephritis

Question 56

NephrOtic syndrome:

Answer 56

- HypOalbuminemia - hyperlipidemia - MASSIVE proteinuria - Peripheral edema

Question 57

NephrItic syndrome:

Answer 57

- cola-colored urine (=hematuria) - Oliguria - HTN - Berger's Disease (IgA nephropathy) is the MC cause of primary glomerulonephritis