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CPR Exam 3 > Lecture 7: CKD and Kidney Transplant > Flashcards

Lecture 7: CKD and Kidney Transplant Flashcards

1
Q

Acute renal injury/disease is defined by and staged according to what value?

A

Rate of rise in serum creatinine

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2
Q

CKD is defined by and staged using what value?

A

GFR

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3
Q

What GFR is associated with G1 (normal or high)?

A

≥90

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4
Q

What GFR is associated with G2 (mildly decreased)?

A

GFR = 60-89

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5
Q

What GFR is associated with G3a (mildly to moderately decreased)?

A

GFR = 45-59

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6
Q

What GFR is associated with G3b (moderately to severly decreased)?

A

GFR = 30-44

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7
Q

What GFR is associated with G4 (severely decreased)?

A

GFR = 15-29

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8
Q

What GFR is associated with G5 (kidney failure)?

A

GFR <15

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9
Q

What is the first systemic sign of CKD seen in stage 2?

A

HTN

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10
Q

Why are there fictitious “normal” sodium levels on serum labs in someone with CKD?

Leads to worsening?

A
  • Due to extracellular volume expansion as excretion decreases
  • Increased H2O dilutes serum, making Na+ levels appear normal
  • This worsens HTN and edema
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11
Q

What type of acidosis is initially present in CKD and what does it progress to?

A
  • Initially = hyperchlorermic metabolic acidsosis
  • Progresses to anion-gap acidosis because of retained organic acids
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12
Q

Presence of acidosis in CDK can induce what type of state?

A

Protein catabolic state

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13
Q

Potassium homeostasis is relatively unaffected in CKD, UNLESS what?

A
  • Increase in dietary intake
  • Use of loop or K+-sparing diuretics
  • Other meds that interfere w/ RAAS (spironolactone, ACE, ARBs)
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14
Q

What happens to levels of vitamin D, calcium, and phosphate levels during uremia seen in CKD?

A
  • HYPO-vitamin D
  • HYPOcalcemia
  • HYPER-phosphatemia
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15
Q

Sx’s of hyperparathyroid include?

A
  • Muscle weakness
  • Nonspecific constitiutional sx’s
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16
Q

What are 3 bone diseases which may develop as a result of uremia?

A
  1. Osteitis fibrosa cystica = high-turnover bone dz
  2. Osteomalacia = defective mineralization
  3. Adynamic bone disease= decreased rate of bone turn-over
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17
Q

Adynamic bone disease associated with CKD is worse in which patients?

A

Diabetes

18
Q

Phosphorus complexes with what causing a further increase in PTH during CKD?

A

Complexes with calcium and deposits in soft tissues

19
Q

What are the toxic cardiovascular effects of PTH seen in CKD?

A
  • Cause cardiac muscle fibrosis
  • Elevated phosphorus/calcium complex increase vascular calcification and atherosclerosis
20
Q

What is the treatment for the toxic cardiovascular effects due to PTH seen in CKD?

A

Supplemental calcitriol (vitamin D analog) to depress PTH

21
Q

What is the #1 cause of mortality in pt with CKD?

A

Cardiovascular disease

22
Q

Decreased erythropoietin production in uremia associated w/ CKD causes what?

A

Normochromic, normocytic anemia

23
Q

What is a cardiovascular effect of the anemia seen in CKD?

A

Left ventricular hypertrophy

24
Q

Elevated PTH, anemia,elevated phosphorus, and acidosis/hyperkalemia are apparent during what stage of CKD?

A

Stage 3

25
Q

Neuromuscular effects of CKD are evident by what stage?

A

Stage 3

26
Q

What are the neuromuscular sx’s seen in stage 3 of CKD?

A
  • Neuromuscular irritability
  • Twitches, cramps, and hiccups
27
Q

Which stage of CKD does peripheral neuropathy become evident?

What type of neuropathy is it initially (sensory/motor) and in which body regions?

A
  • Stage 4
  • Sensory > motor until later stages
  • Lower extremities > upper extremities
28
Q

What are the GI effects of uremia in CKD?

These pts have what characteristic smell to breath?

A
  • Uremic fetor = urine-like odor on breath; unpleasant metallic taste
  • Gastritis, peptic disease and mucosal ulcerations
  • Anorexia, N/V, constipation
29
Q

What are the plasma levels of insulin, estrogen (women), and testosterone (men) like in uremia associated with CKD?

A
  • Insulin levels are increased (usually cleared by kidney)
  • Estrogen and Testosterone is decreased
30
Q

What are effects on the skin associated with uremia in CKD?

A
  • HYPERpigmentation
  • Pruritus = worse w/ hyperphosphatemia
31
Q

What is the first line of treatment for controlling BP in CKD?

A

Control BP —> ACE-I and ARBs

32
Q

What are 2 dietary changes used for TX in someone with CKD?

A
  1. Na+ restriction
  2. Protein restriction - but monitor for malnutrition
33
Q

Medication adjustments in CKD are based off of what?

A

Renal function (GFR)

34
Q

Nephrology referral for CKD should be made when GFR =?

A

GFR <30

35
Q

By what stage should their be a discussion of replacement therapies (i.e., dialysis amd renal transplant) in pt with CKD?

A

No later than stage 4

36
Q

What are 4 nephrotoxic drugs/agents which can worsen CKD?

A
  • NSAIDs
  • Antibiotics
  • Antiarrhythmics
  • Radiocontrast agents and Gadolinium
37
Q

Metabolic acidosis in CKD is related to reduced production of?

A

Ammonia (NH3)

38
Q

What is a long-term and serious complication of peritoneal dialysis involving the bowels?

A

Sclerosing encapsulating peritonitis –> entraps loops of bowel –> sx’s of bowl obstruction

39
Q

What type of dialysis creates an arterial-venous fistula by joining a high pressure vessel to low pressure vessel that becomes an access port?

A

Hemodialysis

40
Q

3 contraindications for renal transplant include?

A
  1. Malignancy
  2. Active infection
  3. Significant cardiopulmonary disease
41
Q

At what GFR should a transplant start being considered?

A

GFR <15

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