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CDM 1 Exam 2 > Renal: Lecture 3 > Flashcards

Renal: Lecture 3 Flashcards

1
Q

Where do nephrons live in kidney?

A

Medulla and Cortex

Drain into renal pelvic

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2
Q

Inactive form of vitamin D

A

25 (OH) - D

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3
Q

Active form of Vitamin D

A

1,25 (OH)2D

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4
Q

Proposed mechanisms for CKD progression

A

Diabetes mellitus
Systemic Hypertension
Glomerulosclerosis

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5
Q

How do we get CKD from Systemic Hypertension

A

Increase in glomerular capillary pressure

Thickening of blood vessels, reducing blood flow, leading to decreased perfusion, so body will activate RAAS to try to address and makes it all worse

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6
Q

How do we get CKD from Diabetes mellitus

A

High glucose = high glucose in urine causing damage in cells. Causes scaring, Mesangial cells will expand pushing on blood vessels to constrict them.

High glucose can also lead to oxidative stress leading to dec GFR and loss of nephron

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7
Q

How do we get CKD from Glomerulosclerosis

A

Scar tissue is developed in Glomerulus

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8
Q

Hypertension CKD Pathogenesis

A

Hypertension leads to thickening and narrowing of artery and afferent arteriole.

Decrease in GFR, causes Renin secretion and Activation of RAAS.

RAAS leads to more hypertension

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9
Q

Modifiable CKD Risk factors

A

*Diabetes
*Hypertension
Hyperlipiddemia
Tobacco use
Proteinuria
History of AKI

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10
Q

Non-modifiable CKD Risk factors

A

Age 60+
FH of kidney disease
Ethnicity: AA, Hispanic, Asian, American Indian

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11
Q

Common causes of CKD

A
  • Hypertension
  • Diabetes

Acute kidney injury
Polycystic kidney disease
Other (Meds, etc)

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12
Q

Physical Signs of CKD

A 
Swelling/Edema
Back pain
Blod in urine
Decreased urine output
Frothiness of urine
** Usually Asymptomatic, Especially early stage**
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13
Q

Labs present for CKD

A

Either of these must be present for >3 months

eGFR <60
UACR >30
Markers of kidney damage (1 or more0

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14
Q

Markers of Kidney Damage

A

Urinalysis abnormalities
Kidney biopsy abnormalities
Polycystic kidney disease on imaging studies

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15
Q

Differences between AKI and CKD

A

AKI: Short time frame, Double in SCr

CKD: Over prolonged period of time, dec eGFR and inc UACR

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16
Q

GFR gives estimation of….

A

function and filtration

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17
Q

UACR provides info regarding

A

Extent of kidney damage

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18
Q

GFR decrease with age

A

1ml/min after 30 years old

19
Q

MDRD equation is…

A

more acurrate if eGFR is <60

20
Q

CKD-EPI equation is….

A

more accurate than MDRD if actual GFr >60

21
Q

GFR of a health individual is estimated to be about….

A

100-120ml/min

22
Q

Cockcroft-Gault is used for….

A

Creatine clearance, which is used for Drug Dosing

23
Q

Cockcroft-Gault equation and IBW equation

A

Male: ((140-age) X IBW)/(SCr X 72
IBW = 50 + 2.3(# in over 5ft)

Female: ((140-age) X IBW)/(SCr X 72) * 0.85
IBW: 45.5 + 2.3(# in over 5ft)

24
Q

A1 Albuminuria Stage

A

<30, now termed normal to mildly increased

25
Q

A2 Albuminuria Stage

A

30-300, microalbuminuria

moderately increased

26
Q

A3 Albuminuria Stage

A

> 300, macroalbuminuria

severely increased

27
Q

Nephrotic Syndrome Stage

A

> 2000mg

28
Q

Stage 1 CKD

A

Kidney damage with normal kidney function 90-100%

GFR >90

29
Q

Stage 2 CKD

A

Kidney damage with mild loss of kidney function 60-89%

GFR 60-89

30
Q

Stage 3a CKD

A

Mild to moderate loss of kidney function, 45-59%

GFR 45-59

31
Q

Stage 3b CKD

A

Moderate to severe loss of kidney function, 30-44%

GFR 30-44

32
Q

Stage 4 CKD

A

Severe loss of kidney function, 15 to 29%

GFR 15-29

33
Q

Stage 5 CKD

A

Kidney Failure, <15%

GFR <15

34
Q

When is renal replacement therapy considered?

A

Stage 5 (ESRD)

Ex. Dialysis or Kidney Transplant

35
Q

Clinical presentation of CKD Stage 1/2

A

Increase SrCr, BUN, decrease GFR
Electrolyte abnormalities maybe
Possible anemia (low incidence), monitor Hgb/Hct

36
Q

Indications for Dialysis

A 
A: Acidosis
E: Electrolyte abnormalities
I: Ingestion of toxic dialyzable substances
O: overload of fluid
U: Uremia
37
Q

Treatment goals of CKD

A

Delay progression of CKD
Minimize development of complications, including CVD
Decrease incidence of ESRD and need for dialysis

38
Q

Primary prevention of CKD

A

Preventing development of CKD

39
Q

Secondary prevention of CKD

A

Preventing progression of CKD and associated complications

40
Q

Tertiary prevention of CKD

A

Treating Kidney Failure

41
Q

BP goal for CKD based on KDIGO

A

** < 130/80 **

42
Q

Lifestyle recommendations for CKD patients

A

Lower dietary protein intake if GFR <30
Avoid high protein intake in adults with CKD at risk
Lower salt to <2g
Control salt, potas, phos and protein in advanced CKD
30min 5/week physical activity
Healthy BMI 20-25
Tobacco cessation

43
Q

Patient education for CKD

A

influence of risk factor modification on disease progression

Clinical sequelae of disease progression

Pharmacologic therapies and lifestyle modifications

Importances of checking w/ pharmacist on OTC meds/supplements/etc

44
Q

Self-care counseling in CKD

A

NSAIDs should be avoided

Antacids calcium containing safest choice
ex. AlkaSeltzer, Pepcid, Magnesium, PPI = avoid?

CDM 1 Exam 2 (16 decks)

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