Renal Health Maintenance

Question 1

Hepatitis A

Answer 1

Vaccination on a schedule of 0, 1, and 6 months

Question 2

Hepatitis B

Answer 2

Need surface antigen testing for HBV (HBsAg) and HBV antibody testing before initiation of dialysis
Seroconversion rates worsen as renal disease progresses
Series of 3 injections 0, 1-2, & 4-6 months

Question 3

Hepatitis C

Answer 3

Not a vaccine, however good idea to screen for
Increase seroconversion with patients on dialysis
ESRD patients with Hep C must be treated before transplant d/t rejection

Question 4

Blood glucose control

Answer 4

Diabetes primary cause of kidney failure
Progression of CV complications with poor glycemic control
HbA1c level should be controlled to less than 7
Metformin should be avoided is CR >1.5

Question 5

Prostate cancer screening

Answer 5

50 years and older DRE and PSA
high risk patinets at age 40 with DRE and PSA
PSA 0.6 or > if Africa American/Family history get annual DRE/PSA
PSA 0.6 at age 45, repeat annually
PSA <0.6 at age 45, rescreening offered at age 50

Question 6

Colorectal cancer

Answer 6

Colonoscopy at age 50 and repeat every 10 years if the initial was negative
Annual fecal occult blood test
Flexible sigmoidoscopy every 5 years

Question 7

Breast cancer

Answer 7

Women age 20-39 have clinical breast exams every 1-3 years

Women 40 or more years have clinical breast exams and screening mammogram

Question 8

Referral to Nephrologist GFR

Answer 8

<15 Immediate referral
15-29 Urgent referral (routine if known to be stable)
30-59 Routine referral
60-89 Referral not required unless high risk issues present