The damn kidney Flashcards
Who should you screen for CKD and what should you use
Hypertension CVD Diabetes Indigenous people First degree relative with CKD
Use GFR NOT 24 hour urine
When do you diagnose CKD
GFR<60 and/or ACR>3
When do you refer to someone who actually understands the kidney
GFR <30 ACR>60 Or if rapid decline HTN not at target Electrolytes abnormal RBC casts or hematuria
KFRE >5 %
How can we predict what will happen to the kidneys
Kidney Failure risk equation
looks at age, sex, GFR, ACR and predicts in the next 2 and 5 years chance of dialysis or transplant
If a patient is not at the point of referal what do we do to monitor their kidneys
GFR ACR Lytes Urinalysis Urine microscopy
q 6 months or anually if stable for 2 years
How do we manage CKD
Smoking cessation Statins if at risk Review side day medications Adjust dosage of medications Reduce BP ACE or ARB
List the sick day medications
Sulfonylureas ACE Diuretics Metformin ARB NSAIDS SGLT2 inhibitors
What is RIFLE
Risk, injury, failure, loss, end stage in reference to kidney failure
Risk=75% of normal
Injury=50% of normal
Filure=25% of normal
Loss is complete loss of function for 4 weeks
End stage is complete loss of function for 3 months
What do you do in AKI
Stop nephrotozic drugs, poly pharmacy, and any radio contrast
Monitor colume status and urine output
Ensure proper hydration
Someone on dialysis comes in with a fever. What do they have until proven otherwise
Spontaneous Bacterial Peritonitis
List ten risk factors for CKD
Diabetes HTN Vascular disease Autimmune glomerular disease UTI Stones Obstruction PCKD Age Obesity Smoking
List five symptoms of kidney failure
Edema Fatigue Oliguira Anemia Nausea Pruritis
What imaging do you want to do for kidney failure and what are you looking for
US KUB Stones Masses Cysts Size discrepancy
List three non pharm management of CKD
Watch diet for potassium, and sodium 0.8 g/kg per day of protein Weight control Exercise Smoking cessation moderate alcohol consumption
Ensure flu shot, pneumococcal, HEP B
Advanced care planning
When to start an ACEARB and what to monitor
Start if CKD WITH proteinuria
Monitor CR potassium 2-4 weeks after starting
Reduce dose if Hyperkalemia or >30% increase to creat
