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CMN572 > U4: CKD > Flashcards

U4: CKD Flashcards

1
Q

CKD definition: ______+ months of ______ or _______

A
  • 3+ months
  • kidney damage
  • or eGFR <60
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2
Q

2 dominant risk factors for CKD

A
  • DM

* HTN

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3
Q

4 interventions to reduce CKD progression

A
  1. BP control <130/80
  2. use of ACE-I/ARB for albuminuria & HTN
  3. DM control
  4. correction of metabolic acidosis
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4
Q

pt’s with either _____ or _____ dx should have target testing for CKD

A
  • DM

* HTN

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5
Q

pts w either DM or HTN should have target testing for _____

A

CKD

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6
Q

what is the most accurate lab for measuring kidney function

A

eGFR

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7
Q

urine studies for CKD

A
  • albuminuria for prognosis

* UACR: more sensitive & specific marker for CKD than spot urine protein/creatinine ratio

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8
Q

treatment aim for CKD:

A
  • delay progressive loss of kidney function

* prevent/manage complications

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9
Q

interventions to delay CKD Progression include use of a _______ blocker such as an ______ or ________ for the pt with albuminuria and HTN

A
  • RAAS
  • ACE-I
  • ARB
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10
Q

what are the eGFR function categories?

A

G1, G2, G3a, G3b, G4, G5

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11
Q

eGFR range for G1? and what level of funx does this correlate with?

A
  • <90

* Normal or High function

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12
Q

eGFR range for G2? and what level of funx does this correlate with?

A
  • 60-89

* Mildly decreased

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13
Q

eGFR range for G3a? and what level of funx dose this correlate with?

A
  • 45-59

* mildly to moderately decreased

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14
Q

eGFR range for G3b? and what level of funx does this correlate with?

A
  • 30-44

* moderately to severely decreased

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15
Q

eGFR range for G4? and what level of funx does this correlate with?

A
  • 15-29

* severely decreased

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16
Q

eGFR range for G5? and what level of funx does this correlate with?

A
  • <15

* kidney failure

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17
Q

primary intervention for metabolic syndrome?

A

lifestyle mods

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18
Q

“clinical” ASCVD pts need ____ intensity statin to decrease risk

A
  • HIGH

* or max tolerated dose

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19
Q

very high risk ASCVD pts: use a LDL goal of

A

*70

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20
Q

Very high risk ASCVD pt unable to reach LDL goal (of?) on highest tolerated statin therapy- what do you prescribe next?

A
  • 70

* ezetimibe

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21
Q

very high risk ASCVD pt. on highest tolerated statin dose AND ezetemibe. LDL still not at goal (of?). what do you prescribe next?

A
  • 70

* PCSK9 inhibitors

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22
Q

severe primary hypercholesteremia is defined as LDL-C level over or equal to

A

*190

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23
Q

severe primary hypercholesteremia get _____ intensity statin regardless of ASCVD risk?

A

*high intensity statin

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24
Q

pt w severe primary hypercholesterolemia on high intensity statin and still not at LDL goal (of?). what do you add next?

A
  • <100

* ezetemibe

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25
pt w severe primary hypercholesterolemia on _____ intensity statin AND _______ and still not at LDL goal (of?). what do you order?
* high * ezetimibe * 100 * PCSK9 inhibitor IF the pt has multiple ASCVD RF
26
40-75yo pt w DM. what is their LDL goal?
<70
27
40-75yo pt w DM and LDL at/above LDL goal (of?) get a _____ intensity statin regardless of ASCVD risk
* 70 | * moderate
28
for DM pts with LDL above goal (of?) as well as _______ risk factors & those between the ages of 50-75 it is reasonable to use a ______ intensity statin
* <70 * ASCVD RF * HIGH
29
complications begin in which stage of CKD?
3
30
what labs do we want to draw in CKD stage 3?
* Calcium, Phos Q6-12m * PTH once then based on CKD progression * 25(OH)D once then based on levels and treatments or annually
31
eGFR is the most accurate assessment of ?
kidney function (except during AKI)
32
albuminuria is critical to evaluate?
PROGNOSIS | A stages
33
spot albumin-to-creatinine-ratio (UACR) is more or less sensitive and specific marker of CKD than spot urine PROTEIN/CR ratio
MORE. | UACR IS MORE S&S FOR CKD than UPCR
34
complications of CKD nemonic: SPACE
``` S = sodium balance P = potassium excretion A = acid excretion C = calcium/phosphate balance E = erythropoiesis ```
35
sodium balance comps in CKD =
sodium retention & volume overload
36
potassium excretion comps in CKD?
hyperkalemia
37
acid secretion comps in CKD?
metabolic acidosis
38
calcium/phosphate balance comps in CKD?
* hyperPHOS * hyperPTH * low calcium * low calcitriol (vit d3)
39
erythropoiesis comps in CKD?
*anemia
40
sodium imbalance treatment for CKD?
* sodium restriction | * diuretics
41
potassium imbalance treatment for CKD?
* dietary restriction | * avoid NSAIDS
42
acid excretion imbalance treatment for CKD?
*sodium bicarb
43
markers of kidney damage include?
* 1+ glomerular hematuria * abn kidney biopsy * polycystic kidney dx on imaging
44
normal eGRF varies w age, sex, body size. true or false?
TRUE
45
ethnic RF for CKD
``` AA hispanic asian PI american indian ```
46
(serum? as opposed to urine?) ACR provides insight regarding ______ of kidney damage
*extent
47
spot UACR quantifies _______
proteinuria
48
CKD pts are prone to high levels of which electrolytes?
*K *Mag Phosphate
49
CKD pts are prone to low levels of which serum component?
glucose | *hypoglycemic
50
gadolinium based contrast. safe for kidneys or no?
NO, esp eGFR<30% | *nephrogenic systemic fibrosis
51
sodium phosphate bowel prep ok for CKD?
NO | *AKI, CKD
52
complications showing up in CKD stage 3
* anemia * bone & mineral issues * CV disease * low serum albumin
53
LOOK AT entire UA to assess for?
* early signs | * Protein, RBC, WBC in urine
54
low urine pH might alert you to early problem before ______ dx
CKD
55
high urine specific gravity might alert you to an early problem before _____ dx
CKD
56
albuminuria normal range
<30
57
albuminuria moderate range
30-299
58
albuminuria severe range
300+
59
labs drawn at stage 3 (ICAP)
* intact PTH * calcium * albumin * phos
60
proteinuria = > _____ on urine dipstick
30
61
refer to nephro eGFR
30
62
refer to nephro: persistent ______
albuminuria >300
63
refer to nephro: ______ progression
atypical
64
refer to nephro: decline in eGFR of ______ from baseline in _____
* 25+% | * 4m
65
refer to nephro: rapid progression of CKD = sustained decline of > ________
5ml/min/year
66
refer to nephro: CKD of ______ origin
*unknown
67
refer to nephro: persistent ______>20
RBC
68
refer to nephro: HTN refractory to _____ meds
4
69
refer to nephro: persistent elevation of serum _____-
K
70
refer to nephro: recurrent or extensive
*nephrolithiasis
71
refer to nephro: _____ kidney disease
*hereditary
72
CKD stage 3. draw calcium and phosphorus every?
6-12m
73
CKD stage 3. draw intact PTH?
once then based on progression
74
CKD stage 3. draw 25(OH)D?
once then based on levels/treatments OR annually
75
vaccines for CKD, esp when eGFR<30
* Flu * PNA = PCV13 then 12mo later PPSV23 * Hep B & confirm titers
76
common meds requiring dose reduction: AGRNBD
* allopurinol * gabapentin * reglan * narcs (methadone, fentanyl) * beta blockers (ateno/biso/nado) * Digoxin
77
common meds requiring dose reduction: SAMEC
* statins (lova, prava, simva, fluvs, rosu * antimicrobials (aminoglycosides, bactrim, macrobid) * methotrexate * enoxaparin * colchicine
78
treatment for hyperkalemia?
* reduce dietary intake * stop NSAIDS & Cox2's * stop K sparing diuretics (spirono, eplernone, amiloride) * avoid salt subs
79
ESRD refers to what eGFR range?
<15ml/min
80
refer to nephro: secondary _____
*hyperparathyroidism
81
refer to nephro: recurrent
kidney stones
82
CKD & CVD. age to consider "lipid lowering therapy"
>50y
83
CKD & CVD ages 18-50 at high CVD risk should consider what medicatoin?
lipid lowering therapy
84
refer to nephro for ESA to treat hgb < ?
10
85
age over _____ increases your risk for CKD?
60
86
hx of ____ increases your risk for CKD
AKI
87
CKD pts are at increased risk for LV hypertrophy. true or false?
TRUE
88
what diuretic should choose in early CKD?
thiazide
89
what diuretic should choose if eGFR <30ml
LOOP
90
what drugs for proteinuria?
ACE/ARB | *must monitor serum CR & K w/i 1-2w of start and dose change
91
CKD & HF. DO NOT give what common med & why?
* DIG | * excreted by kidneys... can build up & become toxic
92
if your pt has pleuritic CP and a pericardial friction rub what do you suspect?
pericarditis ST uremia. REFER TO ED FOR HD
93
secondary hyperPTH can contribute to vascular ______ & accelerate CVD
calcification
94
if hyperphosphatemia not controlled with diet then what rx?
*phosphate binders TID w meals *sevelamer carbonate OR *aluminum hydroxide
95
hyper PHOS tx. once levels are controlled?
treat secondary hyperparathyroidism w vitamin D
96
active vitamin D AKA
calcitriol
97
cinacalcet suppresses ____ production
PTH | *mimics calcium & takes up receptors
98
calcitriol increases serum ______ & _____ Levels & must be monitored closely
calcium | phosphorus
99
dialysis is considered at a eGFR of?
<10
100
kidney transpant average wait time is ?
2-6y
101
mortality for patients undergoing HD during ESRD is higher or lower than for those not on HD?
HIGHER
102
high ________ growth factor (FGF-23) levels are a new marker for mortality in ESRD
*FIBROBLAST
103
phos binders required at what eGFR?
<20-30
104
K restriction is required at what eGFR?
<10-20
105
1+ glomerular hematuria is a sign of ?
kidney damage
106
1+ ______ hematuria is a sign of kidney damage
glomerular
107
1+ glomerular ________ is a sign of kidney damage
hematuria

CMN572 (13 decks)

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