Lecture 7: CKD and Kidney Transplant Flashcards
Acute renal injury/disease is defined by and staged according to what value?
Rate of rise in serum creatinine
CKD is defined by and staged using what value?
GFR
What GFR is associated with G1 (normal or high)?
≥90

What GFR is associated with G2 (mildly decreased)?
GFR = 60-89

What GFR is associated with G3a (mildly to moderately decreased)?
GFR = 45-59

What GFR is associated with G3b (moderately to severly decreased)?
GFR = 30-44

What GFR is associated with G4 (severely decreased)?
GFR = 15-29
What GFR is associated with G5 (kidney failure)?
GFR <15
What is the first systemic sign of CKD seen in stage 2?
HTN

Why are there fictitious “normal” sodium levels on serum labs in someone with CKD?
Leads to worsening?
- Due to extracellular volume expansion as excretion decreases
- Increased H2O dilutes serum, making Na+ levels appear normal
- This worsens HTN and edema
What type of acidosis is initially present in CKD and what does it progress to?
- Initially = hyperchlorermic metabolic acidsosis
- Progresses to anion-gap acidosis because of retained organic acids
Presence of acidosis in CDK can induce what type of state?
Protein catabolic state
Potassium homeostasis is relatively unaffected in CKD, UNLESS what?
- Increase in dietary intake
- Use of loop or K+-sparing diuretics
- Other meds that interfere w/ RAAS (spironolactone, ACE, ARBs)
What happens to levels of vitamin D, calcium, and phosphate levels during uremia seen in CKD?
- HYPO-vitamin D
- HYPOcalcemia
- HYPER-phosphatemia

Sx’s of hyperparathyroid include?
- Muscle weakness
- Nonspecific constitiutional sx’s
What are 3 bone diseases which may develop as a result of uremia?
- Osteitis fibrosa cystica = high-turnover bone dz
- Osteomalacia = defective mineralization
- Adynamic bone disease= decreased rate of bone turn-over
Adynamic bone disease associated with CKD is worse in which patients?
Diabetes
Phosphorus complexes with what causing a further increase in PTH during CKD?
Complexes with calcium and deposits in soft tissues

What are the toxic cardiovascular effects of PTH seen in CKD?
- Cause cardiac muscle fibrosis
- Elevated phosphorus/calcium complex increase vascular calcification and atherosclerosis
What is the treatment for the toxic cardiovascular effects due to PTH seen in CKD?
Supplemental calcitriol (vitamin D analog) to depress PTH
What is the #1 cause of mortality in pt with CKD?
Cardiovascular disease
Decreased erythropoietin production in uremia associated w/ CKD causes what?
Normochromic, normocytic anemia

What is a cardiovascular effect of the anemia seen in CKD?
Left ventricular hypertrophy
Elevated PTH, anemia,elevated phosphorus, and acidosis/hyperkalemia are apparent during what stage of CKD?
Stage 3

Neuromuscular effects of CKD are evident by what stage?
Stage 3
What are the neuromuscular sx’s seen in stage 3 of CKD?
- Neuromuscular irritability
- Twitches, cramps, and hiccups
Which stage of CKD does peripheral neuropathy become evident?
What type of neuropathy is it initially (sensory/motor) and in which body regions?
- Stage 4
- Sensory > motor until later stages
- Lower extremities > upper extremities
What are the GI effects of uremia in CKD?
These pts have what characteristic smell to breath?
- Uremic fetor = urine-like odor on breath; unpleasant metallic taste
- Gastritis, peptic disease and mucosal ulcerations
- Anorexia, N/V, constipation
What are the plasma levels of insulin, estrogen (women), and testosterone (men) like in uremia associated with CKD?
- Insulin levels are increased (usually cleared by kidney)
- Estrogen and Testosterone is decreased
What are effects on the skin associated with uremia in CKD?
- HYPERpigmentation
- Pruritus = worse w/ hyperphosphatemia
What is the first line of treatment for controlling BP in CKD?
Control BP —> ACE-I and ARBs
What are 2 dietary changes used for TX in someone with CKD?
- Na+ restriction
- Protein restriction - but monitor for malnutrition
Medication adjustments in CKD are based off of what?
Renal function (GFR)
Nephrology referral for CKD should be made when GFR =?
GFR <30
By what stage should their be a discussion of replacement therapies (i.e., dialysis amd renal transplant) in pt with CKD?
No later than stage 4
What are 4 nephrotoxic drugs/agents which can worsen CKD?
- NSAIDs
- Antibiotics
- Antiarrhythmics
- Radiocontrast agents and Gadolinium
Metabolic acidosis in CKD is related to reduced production of?
Ammonia (NH3)
What is a long-term and serious complication of peritoneal dialysis involving the bowels?
Sclerosing encapsulating peritonitis –> entraps loops of bowel –> sx’s of bowl obstruction
What type of dialysis creates an arterial-venous fistula by joining a high pressure vessel to low pressure vessel that becomes an access port?
Hemodialysis

3 contraindications for renal transplant include?
- Malignancy
- Active infection
- Significant cardiopulmonary disease
At what GFR should a transplant start being considered?
GFR <15