renal reviewed 8/6 Flashcards
CKD criteria
either of the following for >3 months
- markers of kidney damage (one or more)
- decreased GFR (<60)
GFR calculation
serum creating or cystatin C with other components
CGA staging
cause
GFR category
albuminuria category
CGA A
A1 - normal to mildly increased albuminuria
A2 - moderately increased albuminuria
A3 - severely increased albuminuria
CGA G
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
clinical proteinurea
> 150-160 mg/24 level period
proteinurea treatment
ACE/ARB
decrease risk factors - BP<130/80
how to evaluate for structural renal conditions
renal US
look for renal asymmetry, hydronephrosis, cysts, scaring, arterial stenosis
small ethnogenic kidneys (<10 cm bilaterally) - CKD
CKD complications
- 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
ACE/ARB monitoring
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)
when to refer to nephrology
- 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
renal diet
low salt
low protein
low potassium
low phosphorus
when will you see creatinine bump with contrast
24-72 hours later
prevention of contrast associated AKI
prevent!
500 ml 0.9% before contrast
3 ml/kg 1 hour before, then 1 ml/kg/hour for 6 hours after
when to initiate acute RRT
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
