renal reviewed 8/6 Flashcards

1
Q

CKD criteria

A

either of the following for >3 months

  • markers of kidney damage (one or more)
  • decreased GFR (<60)
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2
Q

GFR calculation

A

serum creating or cystatin C with other components

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3
Q

CGA staging

A

cause
GFR category
albuminuria category

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4
Q

CGA A

A

A1 - normal to mildly increased albuminuria
A2 - moderately increased albuminuria
A3 - severely increased albuminuria

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5
Q

CGA G

A

G1 - normal (>90) with evidence of kidney disease
G2 - mildly decreased (60-89)
G3a - mild to moderately decreased (45-59)
G3b - moderately to severely decreased (30-44)
G4 - severely decreased (15-29)
G5 - kidney failure (<15) - RRT

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6
Q

clinical proteinurea

A

> 150-160 mg/24 level period

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7
Q

proteinurea treatment

A

ACE/ARB
decrease risk factors - BP<130/80

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8
Q

how to evaluate for structural renal conditions

A

renal US

look for renal asymmetry, hydronephrosis, cysts, scaring, arterial stenosis

small ethnogenic kidneys (<10 cm bilaterally) - CKD

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9
Q

CKD complications

A
  • HTN - keep <140/90 w ACE/ARB
  • anemia - erythropoietin stimulating agents (R/O other causes)
  • nutritional status - protein malnutrition
    abnormalities of bone, calcium, phosphorus (phosphate binders)
  • neuro changes
  • functioning and well being/mental health
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10
Q

ACE/ARB monitoring

A

serum K/crt before starting
K/crt 1-2 weeks after initiation or dose increase
do not start in K>5

if crt rises >30% or GFR falls by >25%… repeat CMP & evaluate for other causes. if no other causes, consider renal artery stenosis

if crt rises <30% or GFR falls by <25%…. repeat CMP & evaluate for other causes. if no other causes, observe & remove cause if possible

if K>6, repeat CMP and stop contributing drugs (NSAIDs, diuretics, abx). if persists, then hold ACE/ARB

AKI risk may want to hold ACE/ARB (vomiting)

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11
Q

when to refer to nephrology

A
  • GFR <30
  • 25% drop in GFR
  • progression of CKD with a sustained GFR of more than 5 per year
  • significant albuminuria
  • persistent unexplained hematuria
  • secondary hyperparathyroidism, persistent AGMA, non-iron deficiency anemia
  • CKD and HTN refractory to treatment with 4 or more agent
  • persistent K abnormalities
  • recurrent or extensive nephrolithiasis
  • hereditary kidney disease or unknown cause of CKD
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12
Q

renal diet

A

low salt
low protein
low potassium
low phosphorus

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13
Q

when will you see creatinine bump with contrast

A

24-72 hours later

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14
Q

prevention of contrast associated AKI

A

prevent!

500 ml 0.9% before contrast

3 ml/kg 1 hour before, then 1 ml/kg/hour for 6 hours after

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15
Q

when to initiate acute RRT

A

AEIOI

Acidosis unresponsive to medical therapy
Acute, severe, refractory electrolyte changes
Intoxication with dialyzable drug or toxin
Volume overload unresponsive to diuretic therapy
Uremia

educate pt with GFR <30

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16
Q

complications of hemodialysis

A

common procedural complications

HYPOTENSION

dialysis disequilibrium - headache, N/V, fever/chills, back pain, chest pain, cramps, itching, dyspnea

arrhythmias, air embolism

long term - pneumonia, QOL

17
Q

vascular access complications

A

bleeding
thrombosis
infection
arterial steal syndrome - arterial graft diversion ->ischemia