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General Medicine & Family Medicine > Renal & Urology_Chronic Kidney Disease > Flashcards

Renal & Urology_Chronic Kidney Disease Flashcards

1
Q

The kidneys are responsible for ?

A
  • the following physiologic and chemical functions:
  • Rid body of waste products and excess water in the form of urine
  • Regulate acid-base and electrolyte balance
  • Produce erythropoietin
  • Help control blood pressure (BP) through the renin-angiotensin system
  • Remove excess phosphorus from the blood
  • Convert D3 into calcitriol (active vitamin D)
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2
Q

Renal function, as measured by the glomerular filtration rate (GFR), normally begins to deteriorate in the third or fourth decade of life. True or false?

A
  • True (and by the sixth decade, GFR declines by 1-2 mL/min per year)
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3
Q

what is chronic kidney disease(CKD)?

A
  • Decreased kidney function as evidenced by decreased GFR and/or persistent albuminuria
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4
Q

The continuum of CKD is divided into five stages based on _____________

A

Glomerular filtration rate

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5
Q

What is the normal GFR?

A
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6
Q

What is normal GFR and what is GFR at the five stages of CKD?

A
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7
Q

A patient will usually require dialysis when his/her GFR decreases to what level?

A

<15 mL/min/1.73 m 2

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8
Q

Several patients all with the same creatinine level can have different GFRs based on what personal characteristics?

A
  • Age
  • gender
  • race
  • body weight
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9
Q

What two equations can be used to calculate GFR?

A
  • MDRD (Modification of Diet in Renal Disease) or
  • Cockcroft-Gault
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10
Q

It is necessary to obtain a 24-hour urine collection in order to calculate urine albumin excretion. True or false?

A

False. A spot urine albumin to creatinine ratio is adequate and the patient is much more likely to comply with obtaining the test.

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11
Q

What is the equation by which spot urine albumin to creatinine ratio estimates 24 hour urine albumin excretion?

A
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12
Q

What is albuminuria?

A
  • abnormally high urinary albumin excretion (UACR > 30 mg/g)
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13
Q

What is range of UACR for microalbuminuria?

A
  • between 30 and 300 mg/g
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14
Q

What are the two most common causes of CKD in Australian adults?

A
  • diabetes and hypertension.
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15
Q

Under what conditions should patients with this HTN and DM have their urine albumin excretion assessed annually in order to diagnose and monitor CKD?

A
  • patients who have had type one diabetes for more than five years
  • All patients with type two diabetes starting at a terminal diagnosis
  • patients with hypertension who also have diabetes mellitus or kidney disease.
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16
Q

Before diagnosing CKD, acute renal insufficiency/failure should be ruled out. what are some reversible causes of acute kidney disease?

A
  • Following depletion
  • urinary outflow obstruction
  • drug side effects or toxicity.
17
Q

What is the leading cause of death in patients with CKD?

A
  • cardiovascular disease, especially stroke.
18
Q

What is the target BP for patients with CKD?

A
  • BP < 130/80 mm Hg (preferably < 125/75 mmg Hg)
19
Q

What classes of antihypertensives are first line agents for treatment of high blood pressure in patients with CKD?

A
  • renin angiotensin system antagonist
    • angiotensin converting enzyme inhibitors or
    • Angiotensin Receptor Blocker
  • Thiazide diuretics
20
Q

Reduced sodium intake is especially important in hypertensive patients with CKD because sodium control is altered. what is the recommended daily intake of sodium in CKD patients ?

A
  • 2300 milligrams or less.
21
Q

CKD patients should limit their protein intake to what amount per day.

A
  • Non diabetics: 0.8 g/Kg
  • Diabetics 0.8 to 1.0 g/kg
22
Q

In patients with diabetes and CKD who are on insulin, why is it sometimes necessary to decrease the insulin dose even when their diabetes is not necessarily improving?

A
  • worsening kidney function may decrease the breakdown of insulin that is partially metabolized by the kidney and lead to hyperglycemia.
23
Q

What is the main lab value for which nutritional status is monitored in patients with CKD?

A

Albumin

24
Q

What is the main mechanism by which CKD causes, anemia of chronic disease?

A
  • Kidneys produce less erythropoietin, leading to decreased production of red blood cells.
25
Q

What is the general pathophysiology behind renal osteodystrophy?

A
  • In CKD the normal regulation of calcium and phosphorus mediated by vitamin D and parathyroid hormone goes awry and causes bone fragility, pain, and deformation.
26
Q

When a patient has mineral and hormone disorders resulting from CKD what interventions may help to prevent the development or worsening of renal osteodystrophy?

A
  • diet
    • which includes decreased oral intake or phosphorus
    • increased calcium and vitamin D.
  • Dialysis
  • medication - including phosphate binders
  • surgery to remove the parathyroid gland.

General Medicine & Family Medicine (150 decks)

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