nephro case

Question 1

what are the causes of chronic kidney disease

Answer 1

• DM, HTN, Glomerulonephritis

- statins can cause rhabdo – acute renal failure

Question 2

calculating GFR

Answer 2

3. GFR = Creatinine clearance = (140-age x ideal weight (kg)) / (72 x P[creatinine])

Cockroft-Gault estimation

Requires stable serum creatinine, greater in PTs with greater weight, not adjusted for body surface area, can result in overestimate

Question 3

how common is chronic kidney disease

Answer 3

• 13% of Americans have an early form of CKD…aka common

- 2% lifetime risk of ESRD

Question 4

what are the symptoms of chronic kidney disease

Answer 4

Initially asymptomatic.

Advanced renal dysfunction symptoms due to Uremia

• volume overload
• hyperkalemia
• metabolic acidosis
• hypertension
• anemia
• bone disease

Question 5

what meds should you use in chronic kidney disease?

Answer 5

• ACEIs/ARBs – want tight BP control <130/85

- if have cough or angioedema, go with the ARB

Question 6

CKD progression

Answer 6

• renal disease tends to progress to failure/death even if insult is recognized & eliminated
• control via: ACEI/ARBs, diuretics, BP control, salt & protein restriction

Question 7

tx options for CKD

Answer 7

• dialysis and kidney transplant
• patient survival is much better w/ transplant than dialysis
• dialytic mortality is 20% annually

Question 8

hemodialysis

Answer 8

• blood is pumped from the body, filtered through a dialysis machine, and then returned to the body.
• 3x/week for 4 hours (time consuming).
• continuous needle sticks

Question 9

peritoneal dialysis

Answer 9

special fluid is piped into the belly, which collects waste and excess salt and water from the blood, then the used fluid drains out of the belly.

• can be done at home.
• infection, bloating
• all dialysis needs water and sodium restriction

Question 10

complications of dialysis

Answer 10

• temporary placement of a catheter, infection @ access site, fluid/electrolyte d/o’s
• Most common cause of death d/t dialysis is MI!
• Hypertension occurs during dialysis d/t hyperkalemia!
• Stoke is another major complication!

Question 11

article on outcomes/survival on early vs late initiion of dialysis. conclusions?

Answer 11

• clinical outcomes/survival is similar btwn pts in whom dialysis is initiated early and in those in whom its delayed
• results show that w/ careful clinical management, dialysis may be delayed until either the GFR drops below 7ml/min or more traditional indicators for the initiation of dialysis are present

Question 12

kidney transplant

Answer 12

• ESRD is an indication for transplant regardless of the primary cause (GFR <15)
• Benefits: survival is better, no more dialysis, better QOL
• Risks: kidney rejection, infection, bleeding, greater risk of cancer (immunosuppression)
• Barriers: waiting list 3-5 years