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Clin Med Exam 4 > Kidneys Pt 2 > Flashcards

Kidneys Pt 2 Flashcards

1
Q

What is CKD?

A

Kidney damage, or decrased kidney function for greater than 3 months.

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2
Q

What are the most common causes of CKD? What are they at risk for?

A

Diabetes, HTN

CKD patients are at an increased risk for CV disease - leading cause of death in CKD patients

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3
Q

RF for CKD?

A

>60 y/o, HTN, diabetes, CV disease, FH of CKD, Recurrent UTIs, Previous AKI, Nephrolithiasis, Recurrent UTIs, Transplant, Autoimmune dz, smoking

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4
Q

What is creatinine? What’s normal values?

A

Creatinine: a product of musclemetabolism, excreted by kidneys

normal 0.6 - 1.2

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5
Q

What is GFR? What is normal? Whats the gold standard for measurement?

A

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

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6
Q

what are two things to keep in mind for MDRD and cockcroft gault equations?

A

MDRD - shouldn’t be used in AKI

Remember to use ideal body weight in obsese or fluid overloaded patients

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7
Q

What is proteinuria? What causes it?

A

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.

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8
Q

What’s the gold standard for determining proteinuria?

A

24 hour urine collection

Urine protein to creatinine ratio

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9
Q

What is Albuminuria? What are normal levels, microalbuminuria, and Macroalbuminuria?

A

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”

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10
Q

What is the preferred screening test for albuminuria?

A

Urine albumin to creatinine ratio is the preferred screening - yearly screening is recommended.

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11
Q

High albuminuria is associated with?

A

Quicker progression to kidney failure

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12
Q

Early detection of moderately and severely increased albuminuria in diabetics can be treated with?

A

ACEi or ARB and decrase the amount of albuminuria

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13
Q

To prevent or delay progression of microvascular complications of diabetes, including CKD target A1C is?

A

7.0%

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14
Q

A1, A2, A3 correlate with what albuminuria levels?

A

A1 - <30

A2 - 30-300

A3 - >300

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15
Q

G1 and G2 levels are associated with what GFR?

A

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.

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16
Q

G3a is associated with what GFR?

A

45-59 - mild to moderate redcution

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17
Q

G3b is associated with what GFR?

A

30-44 - moderate-severe reduction

18
Q

G4 is associated with what GFR?

A

15-29 - severe reduction

19
Q

G5 is associated with what GFR?

A

<15 - kidney failure

20
Q

What is the normal size of a kidney? What does a shrunken kidney indicate?

A

Normal size is 10cm

Shrunken kidney indicates CKD

Ultrasound can help differentiate between acute and chronic kidney issues.

21
Q

What medications need to be avoided in CKD patients?

A

NSAIDs, Contrast, Magneisum (common in laxatives), Phosphorus (Fleet’s enemas), Aluminium (Maalox, Rolaids), Antimicrobials, Diabetic meds, Decongestants, antihypertensives, opioids & gabapentin

22
Q

What are 7 common complications of CKD

A
  • HTN
  • Hyperphosphatemia
  • Hyperparathyroidism
  • Anemia
  • Hyperkalemia
  • Acidosis
  • Uremic encephalopathy
23
Q

What should you do for hyperphosphatemia in CKD?

A

Give phosphate binders (sevelamer)

Avoid certain foods

24
Q

What should you do for hyperparathyroidism in CKD?

A

Give vitamin D

25
Q

What should you do for Anemia in CKD? What is the goal Hgb?

A

Give EPO, Aranesp (bone marrow stimulant), iron supplementation

Goal Hgb - 10-11

26
Q

What should you do for hyperkalemia in CKD?

A

Low potassium diet, Kayexelate, dialysis

27
Q

What should you do for acidosis in CKD?

A

Sodium bicarb

28
Q

When do you start dialysis?

A

GFR 10-15 - or if unable to control volume status or hyperkalemia

Think ahead - AVF needs about 2 months to mature.

29
Q

How often do you need to do Hemodialysis?

A

3x/week

30
Q

How often do you need to do Peritoneal dialysis?

A

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

Continuous cyclic PD (CCPD) - Machine cylces at night while asleep.

31
Q

Squamous epithelial cells in a UA tell you?

A

Sample is probably contaminated

32
Q

Renal tubular cells/casts in UA tell you?

A

ATN or AIN

Acute tubular necrosis or acute interstitial necrosis

33
Q

RBC casts in a UA indicate?

A

Glomerulonephritis, AIN, vasculitis

34
Q

WBC casts in a UA indicate?

A

Interstitial nephritis, pyelonephritis, inflammation

35
Q

Fatty casts in a UA indicate?

A

Nephrotic syndrome

36
Q

Hyaline casts indicate?

A

Can be normal

37
Q

Muddy brown casts indicate?

A

ATN - acute tubular necrosis

38
Q

What is Nephrotic syndrome?

A

Damage to the glomerular filtration system - Results in

Edema, proteinuria (foamy urine), low serum albumin, Hyperlipidemia

39
Q

Causes of nephrotic syndrome>?

A

Diabetes, minimal change disease, FSGS (focal segemental glomerular sclerosis), membranous nephropathy

40
Q

What is nephritic syndrome?

A

Damage to kidneys that results in

Hypertension, hematuria, proteinuria

41
Q

Causes of nephritic syndrome?

A

Post-infectious glomerulonephritis

IgA nephropathy

Membranoproliferative glomerulonephritis

Clin Med Exam 4 (15 decks)

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