Midterm

Question 1

Initiation of ACEI or ARB monitoring:

Answer 1

Obtain SCr, K, and BP

Question 2

Initiation of ACEI or ARB monitoring:

Answer 2

Obtain SCr, K, and BP

Question 3

When to d/c ACEI or ARB:

Answer 3

SCr increases suddenly by > 30%, hyperkalemia, or hypotensive

Question 4

When to titrate ACEI or ARB:

Answer 4

Every 1 to 3 months until goal is reached

Question 5

Protein intake in dialysis:

Answer 5

1.2 g/kg/day

Question 6

Sodium intake in CKD:

Question 7

Protein intake in any CKD patient:

Answer 7

Do not exceed 1.3 g/kg/day in any adult with CKD

Question 8

CKD w/ diabetes goals:

Answer 8

HbA1c of 7.0%
Reduce proteinuria
Initiate anti-diabetes medications

Question 9

CKD w/ diabetes goals:

Answer 9

HbA1c of 7.0%
Reduce proteinuria
Initiate anti-diabetes medications

Question 10

When to d/c ACEI or ARB:

Answer 10

SCr increases suddenly by > 30%, hyperkalemia, or hypotensive

Question 11

When to titrate ACEI or ARB:

Answer 11

Every 1 to 3 months until goal is reached

Question 12

Protein intake in dialysis:

Answer 12

1.2 g/kg/day

Question 13

Sodium intake in CKD:

Question 14

What to do in CKD w/ diabetes if ACR is not 30-50% after 4-6 weeks:

Answer 14

-Increase dose of ACEI/ARB

Question 15

What to do in CKD w/ diabetes if ACR 30-50% after 4-6 weeks

Answer 15

• Check BP
• If BP is at target, check BP every 3 months
• If BP is not at target, increase dose of ACEI/ARB and/or add thiazide diuretic (add loop if edema is present), then recheck in 4-6 weeks

Question 16

CKD w/ diabetes goals:

Answer 16

HbA1c of 7.0%
Reduce proteinuria
Initiate anti-diabetes medications

Question 17

Metformin continuation in GFR:

Answer 17

• Continue if GFR > 45 mL/min
• Review if GFR is 30-44 mL/min
• Discontinue if GFR

Question 18

ACEI/ARB contraindications:

Answer 18

• Pregnancy
• Renal artery stenosis
• Hx of angioedma

Question 19

What are the BP goals in CKD w/ HTN and w/o diabetes, stage 5?

Answer 19

• Before dialysis: > 120/60

- After dialysis:

Question 20

When to start ACEI or ARB in CKD w/ diabetes:

Answer 20

• Urine albumin > 30 mg/24 hours

- Use w/ caution if GFR

Question 21

When to reassess ACR in CKD w/ diabetes:

Answer 21

Every 4-6 weeks

Question 22

What to do if ACR is not 30-50% after 4-6 weeks:

Answer 22

-Increase dose of ACEI/ARB

Question 23

What to do if ACR 30-50% after 4-6 weeks

Answer 23

• Check BP
• If BP is at target, check BP every 3 months
• If BP is not at target, increase dose of ACEI/ARB and/or add thiazide diuretic (add loop if edema is present)

Question 24

What to do in CKD w/ diabetes if BP is not at target after ACEI/ARB dose increase and/or thiazide (or loop) is added after 4-6 weeks:

Answer 24

• Add DHP CCB

- If required, add other anti-hypertensives (beta-blocker or alpha-blocker to reach BP target)

Question 25

What to do in CKD w/ diabetes if BP target is not at goal after addition of beta-blocker or alpha blocker to ACEI/ARB/diuretic combo:

Answer 25

-Add clonidine, hydralazine, or minoxidil

Question 26

What are the BP goals in CKD w/ HTN and w/o diabetes, stages 1-4?

Answer 26

• 30 mg/24 hours

Question 27

What are the BP goals in CKD w/ HTN and w/o diabetes, stage 5?

Answer 27

• Before dialysis: > 120/60

- After dialysis:

Question 28

What agent(s) are indicated in CKD w/ proteinuria?

Answer 28

• First-line: ACEI/ARB: slows CKD progression
• Non-DHP CCBs (verapamil, diltiazem): decreases amount of protein filtered in glomerulus –> most beneficial in reducing proteinuria when BP