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Clin Med Exam 4 > Kidneys: Part 2 (paulson) > Flashcards

Kidneys: Part 2 (paulson) Flashcards

1
Q

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

A

≥ 3 months

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2
Q

CKD:

-MC causes?

A
  • Diabetes

- HTN

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3
Q

Why we care about CKD?

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

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

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4
Q

___% of high risk patients with CKD are not identified

A

90%

–Leading cause of death in CKD patients

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5
Q

CKD patients are at increased risk for ________ disease

A

Cardiovascular disease

–CV is the leading cause of death in CKD patients

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6
Q

Risk Factors for CKD

A 
>60 years old
HTN
Diabetes
CV disease
FH of CKD
Recurrent UTIs
Previous AKI
Nephrolithiasis
Transplant
Autoimmune Disease
Smoking
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7
Q

Creatinine= a product of _____

A

muscle metabolism, excreted by kidneys

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8
Q

Creatinine

-normal range?

A

0.6-1.2 mg/dl

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9
Q

GFR=

A

Plasma filtration by glomerulus (aka creatinine clearance)

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10
Q

Normal GFR

A

> 90 ml/min/1.73m2

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11
Q

What is the gold standard for measuring GFR?

A

**insulin clearance

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12
Q

Other methods of measuring GFR

A

MDRD and Cockcroft-Gault equations commonly used

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13
Q

MDRD should not be used in Pts with _____

A

AKI

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14
Q

Cockgroft equation requires:

A

Remember to use IBW in obese or fluid overloaded patients

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

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15
Q

Proteinuria=

A

Refers to all types of proteins that might be in urine

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16
Q

Normal level of protein in urine

A

<150 mg/d.

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17
Q

Gold standard test for Proteinuria

A

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

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18
Q

Proteinuria:

-etiology?

A

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

Less concerning causes: exercise, orthostatic proteinuria, acute sickness

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19
Q

Albuminuria is specific to ____

A

**CKD

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20
Q

albuminuria is pathopneumonic for _____

A

kidney damage

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21
Q

Albuminuria can be detected before changes in ______ function occur

A

renal

-**(detects early CKD)

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22
Q

Albuminuria:

-what is the preferred screening test?

A
  • Urine albumin to creatinine ratio preferred screening

- Yearly screening recommended

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23
Q

Normal range of albumin in urine

A

Normal: <30 mg/d

24
Q

Moderately increased albuminuria (range?)

A

Moderately increased albuminuria: 30-300 mg/day

25
Q

Severely increased albuminuria (range?)

A
  • > 300 mg/day

- “Macroalbuminuria”

26
Q

Higher albuminuria is associated with quicker progression to _______

A

kidney failure

27
Q

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

A
  • ACEI or ARB

- albuminuria

28
Q

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

A

7.0%

A1c of 7%= 150mg glucose

29
Q

CKD stage includes

both GFR and ______

A

albuminuria

30
Q

Classification of CKD using GFR and ACR categories

A

image slide 8

31
Q

Normal kidney is ___cm

A

10cm

32
Q

Shrunken kidney indicates _____

A

CKD

33
Q

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

A

acute and chronic kidney issues

34
Q

Medications to avoid/be aware of in CKD patients

A 
NSAIDs
Contrast
Magnesium (common in laxatives)
Phosphorous (Fleet’s enemas)
Aluminum (Maalox, Rolaids)
Antimicrobials
Diabetic meds
Decongestants
Antihypertensives
Opioids & gabapentin
35
Q

Remember
to _______ _____
meds!!

A

Remember
to renally dose
meds!!

36
Q

Complications of CKD

A
  • HTN
  • Hyperphosphatemia:
  • Hyperparathyroidism: Give Vitamin D
  • Anemia
  • Hyperkalemia
  • Acidosis
  • uremic encephalopathy
37
Q

Tx/management of hyperphosphatemia in CKD Pts

A
  • Give phosphate binders (Sevelamer)

- Foods to avoid (dark soda, high protein foods)

38
Q

Tx/management of Anemia in CKD Pts

-what is the goal for Hgb?

A
  • Erythropoietin, Aranesp(bone marrow stimulant), iron supplementation
  • Goal for Hgb: 10-11
39
Q

Tx/management of hyperkalemia in CKD Pts

A

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

40
Q

Tx of Acidosis in CKD Pts

A

Sodium bicarb

41
Q

Dialysis is usually started around GFR of ____

A

10-15

-**Or if unable to control volume status or hyperkalemia

42
Q

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

A

Arteriovenous fistula (AVF) needs about 2 months to mature

43
Q

Hemodialysis (HD) occurs __x a week

A

3x

44
Q

Peritoneal Dialysis (PD):

  • Continuous Ambulatory PD (CAPD)–> how often is tx required?
  • Continuous Cyclic PD (CCPD): how often?
A

Continuous Ambulatory PD (CAPD): 4-5x/day

Continuous Cyclic PD (CCPD): Machine cycles at night while asleep

PD (catheter is inserted into the abdomen)

45
Q

Urine Microscopy findings for CKD:

-if squamous epithelial cells are found, what does this indicate?

A

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

46
Q

Urine Microscopy findings for CKD:

-Renal tubular cells/casts indicate ____

A

ATN or AIN

47
Q

Urine Microscopy findings for CKD:

-RBC casts indicate _____

A

**Glomerulonephritis, AIN, vasculitis

48
Q

Urine Microscopy findings for CKD:

WBC casts indicate ____

A

interstitial nephritis, pyelonephritis, inflammation

49
Q

Urine Microscopy findings for CKD:

-Fatty casts indicate ______

A

nephrotic syndrome

50
Q

Urine Microscopy findings for CKD:

-Hyaline casts indicate _____

A

can be normal

51
Q

Urine Microscopy findings for CKD:

-“Muddy brown casts” indicate _____

A

**ATN

muddy brown=granular casts

52
Q

Nephrotic Syndrome:

  • Sx?
  • Lab findings (on UA)?
  • Lab findings on CBC
A
  • **Edema
  • Proteinuria (foamy urine)
  • **Low serum albumin
  • **Hyperlipidemia
53
Q

Nephrotic Syndrome:

-causes?

A
  • Diabetes
  • Minimal change disease
  • FSGS (Focal segmental glomerular sclerosis)
  • Membranous nephropathy
54
Q

Nephritic Syndrome:

-3 classic findings?

A
  • **Hypertension
  • **Hematuria
  • *Proteinuria (less than nephrotic syndrome)
55
Q

Nephritic Syndrome:

-causes?

A
  • Post-infectious glomerulonephritis
  • IgA nephropathy
  • Membranoproliferative glomerulonephritis
56
Q

NephrOtic syndrome:

A
  • HypOalbuminemia
  • hyperlipidemia
  • MASSIVE proteinuria
  • Peripheral edema
57
Q

NephrItic syndrome:

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

Clin Med Exam 4 (14 decks)

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