Renal & Urology_Chronic Kidney Disease Flashcards
The kidneys are responsible for ?
- 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)
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?
- True (and by the sixth decade, GFR declines by 1-2 mL/min per year)
what is chronic kidney disease(CKD)?
- Decreased kidney function as evidenced by decreased GFR and/or persistent albuminuria
The continuum of CKD is divided into five stages based on _____________
Glomerular filtration rate
What is the normal GFR?
What is normal GFR and what is GFR at the five stages of CKD?
A patient will usually require dialysis when his/her GFR decreases to what level?
<15 mL/min/1.73 m 2
Several patients all with the same creatinine level can have different GFRs based on what personal characteristics?
- Age
- gender
- race
- body weight
What two equations can be used to calculate GFR?
- MDRD (Modification of Diet in Renal Disease) or
- Cockcroft-Gault
It is necessary to obtain a 24-hour urine collection in order to calculate urine albumin excretion. True or false?
False. A spot urine albumin to creatinine ratio is adequate and the patient is much more likely to comply with obtaining the test.
What is the equation by which spot urine albumin to creatinine ratio estimates 24 hour urine albumin excretion?
What is albuminuria?
- abnormally high urinary albumin excretion (UACR > 30 mg/g)
What is range of UACR for microalbuminuria?
- between 30 and 300 mg/g
What are the two most common causes of CKD in Australian adults?
- diabetes and hypertension.
Under what conditions should patients with this HTN and DM have their urine albumin excretion assessed annually in order to diagnose and monitor CKD?
- 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.
Before diagnosing CKD, acute renal insufficiency/failure should be ruled out. what are some reversible causes of acute kidney disease?
- Following depletion
- urinary outflow obstruction
- drug side effects or toxicity.
What is the leading cause of death in patients with CKD?
- cardiovascular disease, especially stroke.
What is the target BP for patients with CKD?
- BP < 130/80 mm Hg (preferably < 125/75 mmg Hg)
What classes of antihypertensives are first line agents for treatment of high blood pressure in patients with CKD?
- renin angiotensin system antagonist
- angiotensin converting enzyme inhibitors or
- Angiotensin Receptor Blocker
- Thiazide diuretics
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 ?
- 2300 milligrams or less.
CKD patients should limit their protein intake to what amount per day.
- Non diabetics: 0.8 g/Kg
- Diabetics 0.8 to 1.0 g/kg
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?
- worsening kidney function may decrease the breakdown of insulin that is partially metabolized by the kidney and lead to hyperglycemia.
What is the main lab value for which nutritional status is monitored in patients with CKD?
Albumin
What is the main mechanism by which CKD causes, anemia of chronic disease?
- Kidneys produce less erythropoietin, leading to decreased production of red blood cells.
