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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
Q

pt w severe primary hypercholesterolemia on _____ intensity statin AND _______ and still not at LDL goal (of?). what do you order?

A
  • high
  • ezetimibe
  • 100
  • PCSK9 inhibitor IF the pt has multiple ASCVD RF
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26
Q

40-75yo pt w DM. what is their LDL goal?

A

<70

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27
Q

40-75yo pt w DM and LDL at/above LDL goal (of?) get a _____ intensity statin regardless of ASCVD risk

A
  • 70

* moderate

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28
Q

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

A
  • <70
  • ASCVD RF
  • HIGH
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29
Q

complications begin in which stage of CKD?

A

3

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30
Q

what labs do we want to draw in CKD stage 3?

A
  • Calcium, Phos Q6-12m
  • PTH once then based on CKD progression
  • 25(OH)D once then based on levels and treatments or annually
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31
Q

eGFR is the most accurate assessment of ?

A

kidney function (except during AKI)

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32
Q

albuminuria is critical to evaluate?

A

PROGNOSIS

A stages

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33
Q

spot albumin-to-creatinine-ratio (UACR) is more or less sensitive and specific marker of CKD than spot urine PROTEIN/CR ratio

A

MORE.

UACR IS MORE S&S FOR CKD than UPCR

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34
Q

complications of CKD nemonic: SPACE

A 
S = sodium balance
P = potassium excretion
A = acid excretion
C = calcium/phosphate balance
E = erythropoiesis
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35
Q

sodium balance comps in CKD =

A

sodium retention & volume overload

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36
Q

potassium excretion comps in CKD?

A

hyperkalemia

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37
Q

acid secretion comps in CKD?

A

metabolic acidosis

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38
Q

calcium/phosphate balance comps in CKD?

A
  • hyperPHOS
  • hyperPTH
  • low calcium
  • low calcitriol (vit d3)
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39
Q

erythropoiesis comps in CKD?

A

*anemia

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40
Q

sodium imbalance treatment for CKD?

A
  • sodium restriction

* diuretics

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41
Q

potassium imbalance treatment for CKD?

A
  • dietary restriction

* avoid NSAIDS

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42
Q

acid excretion imbalance treatment for CKD?

A

*sodium bicarb

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43
Q

markers of kidney damage include?

A
  • 1+ glomerular hematuria
  • abn kidney biopsy
  • polycystic kidney dx on imaging
44
Q

normal eGRF varies w age, sex, body size. true or false?

A

TRUE

45
Q

ethnic RF for CKD

A 
AA
hispanic
asian
PI
american indian
46
Q

(serum? as opposed to urine?) ACR provides insight regarding ______ of kidney damage

A

*extent

47
Q

spot UACR quantifies _______

A

proteinuria

48
Q

CKD pts are prone to high levels of which electrolytes?

A

*K
*Mag
Phosphate

49
Q

CKD pts are prone to low levels of which serum component?

A

glucose

*hypoglycemic

50
Q

gadolinium based contrast. safe for kidneys or no?

A

NO, esp eGFR<30%

*nephrogenic systemic fibrosis

51
Q

sodium phosphate bowel prep ok for CKD?

A

NO

*AKI, CKD

52
Q

complications showing up in CKD stage 3

A
  • anemia
  • bone & mineral issues
  • CV disease
  • low serum albumin
53
Q

LOOK AT entire UA to assess for?

A
  • early signs

* Protein, RBC, WBC in urine

54
Q

low urine pH might alert you to early problem before ______ dx

A

CKD

55
Q

high urine specific gravity might alert you to an early problem before _____ dx

A

CKD

56
Q

albuminuria normal range

A

<30

57
Q

albuminuria moderate range

A

30-299

58
Q

albuminuria severe range

A

300+

59
Q

labs drawn at stage 3 (ICAP)

A
  • intact PTH
  • calcium
  • albumin
  • phos
60
Q

proteinuria = > _____ on urine dipstick

A

30

61
Q

refer to nephro eGFR

A

30

62
Q

refer to nephro: persistent ______

A

albuminuria >300

63
Q

refer to nephro: ______ progression

A

atypical

64
Q

refer to nephro: decline in eGFR of ______ from baseline in _____

A
  • 25+%

* 4m

65
Q

refer to nephro: rapid progression of CKD = sustained decline of > ________

A

5ml/min/year

66
Q

refer to nephro: CKD of ______ origin

A

*unknown

67
Q

refer to nephro: persistent ______>20

A

RBC

68
Q

refer to nephro: HTN refractory to _____ meds

A

4

69
Q

refer to nephro: persistent elevation of serum _____-

A

K

70
Q

refer to nephro: recurrent or extensive

A

*nephrolithiasis

71
Q

refer to nephro: _____ kidney disease

A

*hereditary

72
Q

CKD stage 3. draw calcium and phosphorus every?

A

6-12m

73
Q

CKD stage 3. draw intact PTH?

A

once then based on progression

74
Q

CKD stage 3. draw 25(OH)D?

A

once then based on levels/treatments
OR
annually

75
Q

vaccines for CKD, esp when eGFR<30

A
  • Flu
  • PNA = PCV13 then 12mo later PPSV23
  • Hep B & confirm titers
76
Q

common meds requiring dose reduction: AGRNBD

A
  • allopurinol
  • gabapentin
  • reglan
  • narcs (methadone, fentanyl)
  • beta blockers (ateno/biso/nado)
  • Digoxin
77
Q

common meds requiring dose reduction: SAMEC

A
  • statins (lova, prava, simva, fluvs, rosu
  • antimicrobials (aminoglycosides, bactrim, macrobid)
  • methotrexate
  • enoxaparin
  • colchicine
78
Q

treatment for hyperkalemia?

A
  • reduce dietary intake
  • stop NSAIDS & Cox2’s
  • stop K sparing diuretics (spirono, eplernone, amiloride)
  • avoid salt subs
79
Q

ESRD refers to what eGFR range?

A

<15ml/min

80
Q

refer to nephro: secondary _____

A

*hyperparathyroidism

81
Q

refer to nephro: recurrent

A

kidney stones

82
Q

CKD & CVD. age to consider “lipid lowering therapy”

A

> 50y

83
Q

CKD & CVD ages 18-50 at high CVD risk should consider what medicatoin?

A

lipid lowering therapy

84
Q

refer to nephro for ESA to treat hgb < ?

A

10

85
Q

age over _____ increases your risk for CKD?

A

60

86
Q

hx of ____ increases your risk for CKD

A

AKI

87
Q

CKD pts are at increased risk for LV hypertrophy. true or false?

A

TRUE

88
Q

what diuretic should choose in early CKD?

A

thiazide

89
Q

what diuretic should choose if eGFR <30ml

A

LOOP

90
Q

what drugs for proteinuria?

A

ACE/ARB

*must monitor serum CR & K w/i 1-2w of start and dose change

91
Q

CKD & HF. DO NOT give what common med & why?

A
  • DIG

* excreted by kidneys… can build up & become toxic

92
Q

if your pt has pleuritic CP and a pericardial friction rub what do you suspect?

A

pericarditis ST uremia. REFER TO ED FOR HD

93
Q

secondary hyperPTH can contribute to vascular ______ & accelerate CVD

A

calcification

94
Q

if hyperphosphatemia not controlled with diet then what rx?

A

*phosphate binders TID w meals
*sevelamer carbonate
OR
*aluminum hydroxide

95
Q

hyper PHOS tx. once levels are controlled?

A

treat secondary hyperparathyroidism w vitamin D

96
Q

active vitamin D AKA

A

calcitriol

97
Q

cinacalcet suppresses ____ production

A

PTH

*mimics calcium & takes up receptors

98
Q

calcitriol increases serum ______ & _____ Levels & must be monitored closely

A

calcium

phosphorus

99
Q

dialysis is considered at a eGFR of?

A

<10

100
Q

kidney transpant average wait time is ?

A

2-6y

101
Q

mortality for patients undergoing HD during ESRD is higher or lower than for those not on HD?

A

HIGHER

102
Q

high ________ growth factor (FGF-23) levels are a new marker for mortality in ESRD

A

*FIBROBLAST

103
Q

phos binders required at what eGFR?

A

<20-30

104
Q

K restriction is required at what eGFR?

A

<10-20

105
Q

1+ glomerular hematuria is a sign of ?

A

kidney damage

106
Q

1+ ______ hematuria is a sign of kidney damage

A

glomerular

107
Q

1+ glomerular ________ is a sign of kidney damage

A

hematuria

CMN572 (13 decks)

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