Kidneys Pt 2 Flashcards
What is CKD?
Kidney damage, or decrased kidney function for greater than 3 months.
What are the most common causes of CKD? What are they at risk for?
Diabetes, HTN
CKD patients are at an increased risk for CV disease - leading cause of death in CKD patients
RF for CKD?
>60 y/o, HTN, diabetes, CV disease, FH of CKD, Recurrent UTIs, Previous AKI, Nephrolithiasis, Recurrent UTIs, Transplant, Autoimmune dz, smoking
What is creatinine? What’s normal values?
Creatinine: a product of musclemetabolism, excreted by kidneys
normal 0.6 - 1.2
What is GFR? What is normal? Whats the gold standard for measurement?
Plasma filtration by glomerulus - normal is greater than 90 ml/min/1.73 - starts to decline at age 30
Inulin clearence is the gold standard for measurement - MDRD and Cock-croft gault equations are commonly used
what are two things to keep in mind for MDRD and cockcroft gault equations?
MDRD - shouldn’t be used in AKI
Remember to use ideal body weight in obsese or fluid overloaded patients
What is proteinuria? What causes it?
Refers to all types of proteins that might be in the urine -
Caused by - tubular damage, diabetic nephropathy, glomerulonephritis, rhabdo, Bence Jones proteins,
Less concerning: exercsie, orthostatic proteinuria, acute sickness.
What’s the gold standard for determining proteinuria?
24 hour urine collection
Urine protein to creatinine ratio
What is Albuminuria? What are normal levels, microalbuminuria, and Macroalbuminuria?
This is a protein in the urine that is specific to CKD, it is pathognomonic for kidney damage.
Can be detected before changes in renal funciton - detects early CKD
Normal: <30mg/d
Moderate: 30-300 mg/day - “Micro”
Severe - >300 mg/day - “Macro”
What is the preferred screening test for albuminuria?
Urine albumin to creatinine ratio is the preferred screening - yearly screening is recommended.
High albuminuria is associated with?
Quicker progression to kidney failure
Early detection of moderately and severely increased albuminuria in diabetics can be treated with?
ACEi or ARB and decrase the amount of albuminuria
To prevent or delay progression of microvascular complications of diabetes, including CKD target A1C is?
7.0%
A1, A2, A3 correlate with what albuminuria levels?
A1 - <30
A2 - 30-300
A3 - >300
G1 and G2 levels are associated with what GFR?
G1 - >90 - normal and high
G2 - 60-89 - mild reduction related to normal range for a young adult
NO CKD, in absence of markers of kidney damage.
G3a is associated with what GFR?
45-59 - mild to moderate redcution
G3b is associated with what GFR?
30-44 - moderate-severe reduction
G4 is associated with what GFR?
15-29 - severe reduction
G5 is associated with what GFR?
<15 - kidney failure
What is the normal size of a kidney? What does a shrunken kidney indicate?
Normal size is 10cm
Shrunken kidney indicates CKD
Ultrasound can help differentiate between acute and chronic kidney issues.
What medications need to be avoided in CKD patients?
NSAIDs, Contrast, Magneisum (common in laxatives), Phosphorus (Fleet’s enemas), Aluminium (Maalox, Rolaids), Antimicrobials, Diabetic meds, Decongestants, antihypertensives, opioids & gabapentin
What are 7 common complications of CKD
- HTN
- Hyperphosphatemia
- Hyperparathyroidism
- Anemia
- Hyperkalemia
- Acidosis
- Uremic encephalopathy
What should you do for hyperphosphatemia in CKD?
Give phosphate binders (sevelamer)
Avoid certain foods
What should you do for hyperparathyroidism in CKD?
Give vitamin D
What should you do for Anemia in CKD? What is the goal Hgb?
Give EPO, Aranesp (bone marrow stimulant), iron supplementation
Goal Hgb - 10-11
What should you do for hyperkalemia in CKD?
Low potassium diet, Kayexelate, dialysis
What should you do for acidosis in CKD?
Sodium bicarb
When do you start dialysis?
GFR 10-15 - or if unable to control volume status or hyperkalemia
Think ahead - AVF needs about 2 months to mature.
How often do you need to do Hemodialysis?
3x/week
How often do you need to do Peritoneal dialysis?
Continuous Ambulatory PD (CAPD) - 4-5x/day
Continuous cyclic PD (CCPD) - Machine cylces at night while asleep.
Squamous epithelial cells in a UA tell you?
Sample is probably contaminated
Renal tubular cells/casts in UA tell you?
ATN or AIN
Acute tubular necrosis or acute interstitial necrosis
RBC casts in a UA indicate?
Glomerulonephritis, AIN, vasculitis
WBC casts in a UA indicate?
Interstitial nephritis, pyelonephritis, inflammation
Fatty casts in a UA indicate?
Nephrotic syndrome
Hyaline casts indicate?
Can be normal
Muddy brown casts indicate?
ATN - acute tubular necrosis
What is Nephrotic syndrome?
Damage to the glomerular filtration system - Results in
Edema, proteinuria (foamy urine), low serum albumin, Hyperlipidemia
Causes of nephrotic syndrome>?
Diabetes, minimal change disease, FSGS (focal segemental glomerular sclerosis), membranous nephropathy
What is nephritic syndrome?
Damage to kidneys that results in
Hypertension, hematuria, proteinuria
Causes of nephritic syndrome?
Post-infectious glomerulonephritis
IgA nephropathy
Membranoproliferative glomerulonephritis
