Renal: Lecture 3 Flashcards
Where do nephrons live in kidney?
Medulla and Cortex
Drain into renal pelvic
Inactive form of vitamin D
25 (OH) - D
Active form of Vitamin D
1,25 (OH)2D
Proposed mechanisms for CKD progression
Diabetes mellitus
Systemic Hypertension
Glomerulosclerosis
How do we get CKD from Systemic Hypertension
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
How do we get CKD from Diabetes mellitus
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
How do we get CKD from Glomerulosclerosis
Scar tissue is developed in Glomerulus
Hypertension CKD Pathogenesis
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
Modifiable CKD Risk factors
*Diabetes
*Hypertension
Hyperlipiddemia
Tobacco use
Proteinuria
History of AKI
Non-modifiable CKD Risk factors
Age 60+
FH of kidney disease
Ethnicity: AA, Hispanic, Asian, American Indian
Common causes of CKD
- Hypertension
- Diabetes
Acute kidney injury
Polycystic kidney disease
Other (Meds, etc)
Physical Signs of CKD
Swelling/Edema Back pain Blod in urine Decreased urine output Frothiness of urine ** Usually Asymptomatic, Especially early stage**
Labs present for CKD
Either of these must be present for >3 months
eGFR <60
UACR >30
Markers of kidney damage (1 or more0
Markers of Kidney Damage
Urinalysis abnormalities
Kidney biopsy abnormalities
Polycystic kidney disease on imaging studies
Differences between AKI and CKD
AKI: Short time frame, Double in SCr
CKD: Over prolonged period of time, dec eGFR and inc UACR
GFR gives estimation of….
function and filtration
UACR provides info regarding
Extent of kidney damage
GFR decrease with age
1ml/min after 30 years old
MDRD equation is…
more acurrate if eGFR is <60
CKD-EPI equation is….
more accurate than MDRD if actual GFr >60
GFR of a health individual is estimated to be about….
100-120ml/min
Cockcroft-Gault is used for….
Creatine clearance, which is used for Drug Dosing
Cockcroft-Gault equation and IBW equation
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)
A1 Albuminuria Stage
<30, now termed normal to mildly increased
A2 Albuminuria Stage
30-300, microalbuminuria
moderately increased
A3 Albuminuria Stage
> 300, macroalbuminuria
severely increased
Nephrotic Syndrome Stage
> 2000mg
Stage 1 CKD
Kidney damage with normal kidney function 90-100%
GFR >90
Stage 2 CKD
Kidney damage with mild loss of kidney function 60-89%
GFR 60-89
Stage 3a CKD
Mild to moderate loss of kidney function, 45-59%
GFR 45-59
Stage 3b CKD
Moderate to severe loss of kidney function, 30-44%
GFR 30-44
Stage 4 CKD
Severe loss of kidney function, 15 to 29%
GFR 15-29
Stage 5 CKD
Kidney Failure, <15%
GFR <15
When is renal replacement therapy considered?
Stage 5 (ESRD)
Ex. Dialysis or Kidney Transplant
Clinical presentation of CKD Stage 1/2
Increase SrCr, BUN, decrease GFR
Electrolyte abnormalities maybe
Possible anemia (low incidence), monitor Hgb/Hct
Indications for Dialysis
A: Acidosis E: Electrolyte abnormalities I: Ingestion of toxic dialyzable substances O: overload of fluid U: Uremia
Treatment goals of CKD
Delay progression of CKD
Minimize development of complications, including CVD
Decrease incidence of ESRD and need for dialysis
Primary prevention of CKD
Preventing development of CKD
Secondary prevention of CKD
Preventing progression of CKD and associated complications
Tertiary prevention of CKD
Treating Kidney Failure
BP goal for CKD based on KDIGO
** < 130/80 **
Lifestyle recommendations for CKD patients
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
Patient education for CKD
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
Self-care counseling in CKD
NSAIDs should be avoided
Antacids calcium containing safest choice
ex. AlkaSeltzer, Pepcid, Magnesium, PPI = avoid?
