Lecture 18 - Chronic Kidney Disease

Question 1

Is Acute or Chronic kidney disease associated with Oliguria?

Answer 1

Acute is. Chronic may even result in Polyuria, especially at night.

Question 2

CKD stages (from most severe to least):

Stage 5 = GFR < _____.

Stage 4 = GFR ___ - ___

Stage 3 = GFR ___ - ___

Stage 2 = GFR ___ - ___

Stage 1 = GFR > ___.

What must also be present for Stage 1 and 2 classification?

Answer 2

Stage 5 = GFR < 15.

Stage 4 = GFR 15 - 29

Stage 3 = GFR 30 - 59

Stage 2 = GFR 60 - 89

Stage 1 = GFR > 89

Must also have kidney damage for stage 1 and 2.

Question 3

Both GFR and _____ clearance are important factors for determining Prognosis of CKD.

Answer 3

Albumin

Question 4

African Americans have a higher incidence of mutation in ______, which is a predisposing factor for non-diabetic CKD AND more rapid decline in GFR.

Answer 4

APO-L1

Question 5

Controlling _____ is considered to be the most important factor for controlling CKD. What is the target value for this in Proteinurics and Diabetics?

Answer 5

BP

< 130/80

Question 6

Do not ever combine an ACE inhibitor with what?

Answer 6

ARB (Angiotensin Receptor Blocker)

Question 7

Angioedem and hyper______ are the main CONTRAindications for administration of ACE inhibitors and/or ARBs.

Answer 7

Hyperkalemia

Question 8

What is the biggest comorbid factor and cause of death in CKD patients?

Answer 8

Cardiovascular events

Question 9

Generally speaking, patients of CKD Stage 4 or below should be treated with _____ to help lower lipids and decrease risk of cardiovascular events.

Answer 9

Statins

Question 10

Patients with serum HCO3- < _____ should be treated with supplemental HCO3- (typically Na+HCO3-) to avoid Hyperkalemia. Keep in mind the target is to get serum HCO3- above that mark.

Answer 10

< 20

Question 11

Treating Hyperkalemic patients with low K+ diet is the gold standard. However, medications that bind K+ in the gut to reduce it in serum include SGS, ______, and Sodium Zirconium Cyclosilicate.

Answer 11

SGS, Patiromer, and Sodium Zirconium Cyclosilicate

Question 12

CKD patients with high levels of serum Phosphate have WORSE outcomes. Is inorganic or organic phosphate more readily absorbed from the diet?

Answer 12

Inorganic (very highly present in Colas).

Question 13

Target Phosphate level for ESRD patients is < ____. For non-ESRD CKD patients < ____.

Target Ca++ in CKD of all stages is < _____.

Answer 13

ESRD: < 5.5

Non-ESRD CKD: < 4.5

Ca++ target < 9.5

Question 14

Treatment of CKD patients with which Vit improves outcomes?

Answer 14

1,25 dihydroxy D3

Question 15

Anemia in CKD patients can be caused by absolute deficiency or functional deficiency. In either case, the actions of which molecule are the root cause?

Answer 15

Hepcidin –> in Absolute deficiency it decreases Fe++ absorption in gut; In Functional deficiency it causes Fe++ sequestration from inflammation.

Question 16

CKD can also result in low levels of _____ (hormone secreted by kidneys inresponse to hypoxia to produce more RBCs). Replacement therapy is the treatment, but keep in mind the patient must have adequate _____ (which micronutrient?) for replacement therapy to work.

Answer 16

EPO

Fe++

Question 17

Targeting Hb is a focus of treating anemia in CKD patients. Hb between ___ and ___ is the target range (bringing it up to normal levels was found to INCREASE CV events.)

Answer 17

10 and 12

Question 18

Of the three types of Hemodialysis, which is the best and which is the worst?

Answer 18

AV Fistula (arteriolizes a vein for ease of access and continued access) is the BEST, and Tunneled Catheter is the WORST, but AV Fistula requires 1-3 months to mature, so requires planning.