Nephrology

Question 1

What has been found regarding age adapted cut off for lab values defining CKD?

Answer 1

Current criteria uses same threshold for all ages
May overestimate CKD burden in aging population
Leading to over diagnosis and unnecessary interventions

Question 2

What is the effect of opioids vs. NSAIDs on renal function with CKD patients?

Answer 2

Opioids worse risk of renal and mortality than NSAIDs in patients with CKD

Question 3

What patients have a higher prevalence of UTI?

Answer 3

Institutionalized
Catheter
Diabetic

Question 4

What are negative outcomes of dialysis in older adults?

Answer 4

Painful access surgeries
Lose residual kidney function
Post dialysis fatigue
Functional decline
Inc risk sudden death/stroke
A lot of time in hospital

Question 5

What is the correlation between dialysis and cognitive impairment?

Answer 5

CI at younger age in dialysis patients
Multifactorial etiology
Less in PD vs. HD

Question 6

What is the best way to assess kidney function in AKI vs. CKD?

Answer 6

Underdetect renal disease in older adults due to low muscle mass
AKI - serum Cr
CKD - GFR

Question 7

Why is hyponatremia more common in older adults?

Answer 7

Decreased total body water
Decreased renal sodium conservation availability
Decreased renal water excretion ability
SIADH more common
Medication effects (SSRI, TCA, carbamazepine)
Decrease sodium intake

Question 8

What increases risk of hypernatremia?

Answer 8

Decreased sensitivity to ADH = less able to concentrate urine
Impaired thirst mechanism
Immobility - can’t access water

Question 9

What is average loss of GFR with aging?

Answer 9

After age 40 lose 8 mL/min per decade

Question 10

What age related reasons can predispose elderly towards hyperkalemia?

Answer 10

1. Undiagnosed renal insufficiency
2. Tubulointerstitial disease
3. Decreased aldosterone production
4. Decreased response to aldosterone