Kidneys: Part 2 (paulson) Flashcards
Chronic Kidney Disease (CKD) is kidney damage or decreased kidney function for ___ months
≥ 3 months
CKD:
-MC causes?
- Diabetes
- HTN
Why we care about CKD?
- 59% of Americans develop CKD 3 or higher during life
- About 50% of those with CKD will have an occurrence of AKI
___% of high risk patients with CKD are not identified
90%
–Leading cause of death in CKD patients
CKD patients are at increased risk for ________ disease
Cardiovascular disease
–CV is the leading cause of death in CKD patients
Risk Factors for CKD
>60 years old HTN Diabetes CV disease FH of CKD Recurrent UTIs Previous AKI Nephrolithiasis Transplant Autoimmune Disease Smoking
Creatinine= a product of _____
muscle metabolism, excreted by kidneys
Creatinine
-normal range?
0.6-1.2 mg/dl
GFR=
Plasma filtration by glomerulus (aka creatinine clearance)
Normal GFR
> 90 ml/min/1.73m2
What is the gold standard for measuring GFR?
**insulin clearance
Other methods of measuring GFR
MDRD and Cockcroft-Gault equations commonly used
MDRD should not be used in Pts with _____
AKI
Cockgroft equation requires:
Remember to use IBW in obese or fluid overloaded patients
Cockgroft requires gender, Age, weight, to calculate Creatinine clearance
Proteinuria=
Refers to all types of proteins that might be in urine
Normal level of protein in urine
<150 mg/d.
Gold standard test for Proteinuria
** 24 hour urine –>Urine protein to creatinine ratio
Proteinuria:
-etiology?
-Tubular damage, diabetic nephropathy, glomerulonephritis, rhabdo, Bence Jones proteins
Less concerning causes: exercise, orthostatic proteinuria, acute sickness
Albuminuria is specific to ____
**CKD
albuminuria is pathopneumonic for _____
kidney damage
Albuminuria can be detected before changes in ______ function occur
renal
-**(detects early CKD)
Albuminuria:
-what is the preferred screening test?
- Urine albumin to creatinine ratio preferred screening
- Yearly screening recommended
Normal range of albumin in urine
Normal: <30 mg/d
Moderately increased albuminuria (range?)
Moderately increased albuminuria: 30-300 mg/day
Severely increased albuminuria (range?)
- > 300 mg/day
- “Macroalbuminuria”
Higher albuminuria is associated with quicker progression to _______
kidney failure
Early detection of moderately and severely increased albuminuria in diabetics can be treated with ____ or ____ and decrease the amount of ________
- ACEI or ARB
- albuminuria
Diabetics: Recommended target A1c is ___% to prevent or delay progression of microvascular complications of diabetes, including CKD
7.0%
A1c of 7%= 150mg glucose
CKD stage includes
both GFR and ______
albuminuria
Classification of CKD using GFR and ACR categories
image slide 8
Normal kidney is ___cm
10cm
Shrunken kidney indicates _____
CKD
Kidney size on US can help differentiate b/w ____ and _____ issues
acute and chronic kidney issues
Medications to avoid/be aware of in CKD patients
NSAIDs Contrast Magnesium (common in laxatives) Phosphorous (Fleet’s enemas) Aluminum (Maalox, Rolaids) Antimicrobials Diabetic meds Decongestants Antihypertensives Opioids & gabapentin
Remember
to _______ _____
meds!!
Remember
to renally dose
meds!!
Complications of CKD
- HTN
- Hyperphosphatemia:
- Hyperparathyroidism: Give Vitamin D
- Anemia
- Hyperkalemia
- Acidosis
- uremic encephalopathy
Tx/management of hyperphosphatemia in CKD Pts
- Give phosphate binders (Sevelamer)
- Foods to avoid (dark soda, high protein foods)
Tx/management of Anemia in CKD Pts
-what is the goal for Hgb?
- Erythropoietin, Aranesp(bone marrow stimulant), iron supplementation
- Goal for Hgb: 10-11
Tx/management of hyperkalemia in CKD Pts
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
Tx of Acidosis in CKD Pts
Sodium bicarb
Dialysis is usually started around GFR of ____
10-15
-**Or if unable to control volume status or hyperkalemia
why do you have to “think ahead” when initiating dialysis in a Pt with CKD?
Arteriovenous fistula (AVF) needs about 2 months to mature
Hemodialysis (HD) occurs __x a week
3x
Peritoneal Dialysis (PD):
- Continuous Ambulatory PD (CAPD)–> how often is tx required?
- Continuous Cyclic PD (CCPD): how often?
Continuous Ambulatory PD (CAPD): 4-5x/day
Continuous Cyclic PD (CCPD): Machine cycles at night while asleep
PD (catheter is inserted into the abdomen)
Urine Microscopy findings for CKD:
-if squamous epithelial cells are found, what does this indicate?
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
Urine Microscopy findings for CKD:
-Renal tubular cells/casts indicate ____
ATN or AIN
Urine Microscopy findings for CKD:
-RBC casts indicate _____
**Glomerulonephritis, AIN, vasculitis
Urine Microscopy findings for CKD:
WBC casts indicate ____
interstitial nephritis, pyelonephritis, inflammation
Urine Microscopy findings for CKD:
-Fatty casts indicate ______
nephrotic syndrome
Urine Microscopy findings for CKD:
-Hyaline casts indicate _____
can be normal
Urine Microscopy findings for CKD:
-“Muddy brown casts” indicate _____
**ATN
muddy brown=granular casts
Nephrotic Syndrome:
- Sx?
- Lab findings (on UA)?
- Lab findings on CBC
- **Edema
- Proteinuria (foamy urine)
- **Low serum albumin
- **Hyperlipidemia
Nephrotic Syndrome:
-causes?
- Diabetes
- Minimal change disease
- FSGS (Focal segmental glomerular sclerosis)
- Membranous nephropathy
Nephritic Syndrome:
-3 classic findings?
- **Hypertension
- **Hematuria
- *Proteinuria (less than nephrotic syndrome)
Nephritic Syndrome:
-causes?
- Post-infectious glomerulonephritis
- IgA nephropathy
- Membranoproliferative glomerulonephritis
NephrOtic syndrome:
- HypOalbuminemia
- hyperlipidemia
- MASSIVE proteinuria
- Peripheral edema
NephrItic syndrome:
- cola-colored urine (=hematuria)
- Oliguria
- HTN
- Berger’s Disease (IgA nephropathy) is the MC cause of primary glomerulonephritis
