Lect 4 Flashcards
evaluation of CKD
chronicity: >3 months= CKD
GFR used for staging
albuminuria
identification of CKD progression
annually (more often in high risk)
assess GFR and albuminuria by AER (24 hour) or ACR (shorter time frame)
defined as drop in GFR category
non-diabetic CKD ND treat to less than 140/90 when:
urine albumin less than 30 mg/24 h
> 140 systolic or >90 diastolic
non-diabetic CKD ND treat to less than 130/80 when:
urine albumin > 30 /24 h
BP consistently >130 systolic or >80 diastolic
ACE-I or ARB recommended!
diabetic CKD ND treat to less than 140/90 when:
urine albumin less than 30 mg/24h
> 140 systolic or >90 diastolic
diabetic CKD ND treat to less than 130/80 when:
urine albumin > 30 /24 h
BP consistently >130 systolic or >80 diastolic
ACE-I or ARB recommended!
BP control with ACE-I or ARB
initiate low dose, then titrate at 4 week intervals
increase until proteinuria decreased 30-50% or side effects
(antiproteinuric effects not necessarily obtained at same doses as antihypertensive effects)
BP control with ACE-I or ARB
initiate low dose, then titrate at 4 week intervals
increase until proteinuria decreased 30-50% or side effects
(antiproteinuric effects not necessarily obtained at same doses as antihypertensive effects)
non-DHP CCBs
may have beneficial effects on proteinuria
utilized when ACEI/ARB not tolerated
(diltiazem and verapamil)
DHP CCBs
no additive benefit beyond BP control
combo ACE-I + non-DHP CCB
increased efficacy in reducing proteinuria over either agent alone (more studies needed)
Aliskiren
NOT RECOMMENDED EVER
MDRD analysis
decrease in protein intake could slow progression of renal disease
KDIGO guidelines for protein intake
0.8 g/kg/day for GFR less than 30
(avoid > 1.3 g/kg/day)
very difficult to be compliant with these diets!
target HbA1c in diabetic CKD
approx 7%
>7% if co-morbidities, limited life expectancy, risk of hypoglycemia
