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34 Cards in this Set
- Front
- Back
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End stage renal disease
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Where life can be maintained only by transplantation or dialysis
The most severe version of chronic kidney disease |
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Intact nephron theory of chronic kidney disease pathogenesis
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Diseased nephrons drop out
Remaining nephrons take on much greater fnc (higher GFR, more secretion per nephron) Symptoms take a long time to develop as more and more nephrons are dropping out over time |
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Is ESRD a problem
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Massively shortens life
ESRD patients loose 80% of the life expectancy of a normal person at the time of diagnosis |
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Why is it important to diagnosis chronic kidney disease
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Early disease does show up in lab values
Early treatment can stave off progression CV risk factor treatment can improve outcomes |
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Chronic kidney disease definition
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Kidney disease or more than 3 months
Shown by pathologic abnormalities or blood/urine/imaging abnormalities AND GFR < 60 for > 3 months |
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Symptoms of CKD?
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Usually none till the end
Diagnosis of lab testing |
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Most common stage of CKD?
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Stage 3 - moderate
GFR 30-59 |
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Stages of CKD
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1 - >90
2 - 60-89 3 - 30-59 4 - 15-29 5 - <15 or dialysis |
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Mild CKD increases your risk of...
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Death
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As GFR drops...
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Worsening HTN
Exercise tolerance Hemoglobin Albumin Lytes |
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What kills you in chronic kidney disease?
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CV disease
Not end stage renal failure (although you could get that if you survive your CV disease) |
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Why don't more people progress to ESRD from early CKD?
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They die first
Probably of CV disease |
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Mechanisms of CV risk in kidney disease
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HTN
Endothelial dysfnc, NO bioavailability, ADMA Dyslipidemia, oxidative stress, inflammation RA systemA Vascular calcification, phosphate |
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Albuminuria is marker of
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Glomerular damage
but also can be sign of systemic endothelial dysfunction Even in normal range, increases lead to increased risk of death |
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Risk factors for chronic kidney disease
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Diabetes
HTN Age FHx of kidney disease/diabetes Race: AA, hispanic, pacific islander, native american Tobacco use Anemia High protein diet Atherosclerosis Obesity Nephrotoxic drugs |
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Pathologic correlates of chronic kidney disease
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Tubular atrophy, interstitial fibrosis
glomerular sclerosis, periglomerular fibrosis |
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Recommended screening test for patient at risk for CKD
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Creatinine, GFR estimate
Blood pressure Glucose Urinalysis Microalbuminuria/proteinuria |
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Evaluating CKD by creatinine?
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Not good enough
Calculate the GFR using a predictive equation |
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Monitoring proteinuria?
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Measure the protein to creatinine or albumin to creatinine ration
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Comorbidities of CKD?
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CVD
HTN Anemia Bone disease metabolic alkalosis Protein malnutrition |
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Goals of antiHTN therapy
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Lower BP
Slow progression of CKD Reduce CV risk Modify therapy based on proteinuria |
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Drugs of choice for BP management in CKD
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ACE/ARB
+ Diuretic Calcium channel blocker Beta blocker |
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Cautions with ACEIs in CKD
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10-20% rise in creatinine occurs in 1-2 weeks
Stabilizes but don't combine with NSAIDs, diuretics if this is a problme Not a reason to avoid them in CKD |
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Hematocrit and kidney fnc
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Usually fall concordantly
Kidneys are getting smaller Less epo Also so decreased RBC survival, increased bleeding |
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Symptoms of anemia
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Confusion, impaired cognition
Cardiac enlargement Angina Palpitations Reduced exercise capacity, impaired libido/impotence |
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Where is erythropoetin made?
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Peritubular fibroblasts in kidney
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Treating with epo in CKD?
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Approved in anemia
Elevates HCT Improves QOL Reduces LV mass index epoetin alpha darbopoetin |
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VitD deficiency in phosphate retention
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VitD deficiency leads to phosphate retention
and hypocalcemia which leads to hyperparathyroidism which leads to osteodystrophy |
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GFR and the parathyroid
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When GFR falls, phsophate increases and calcium decreases
PTH is secreted to compensate This works for a while, but eventually the PTH cannot correct the changes |
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FGF23
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Made in bone in response to hyperphosphatemia
Reduces kidney reabsorption But also reduces 1,25 D production...which makes the problem worse in CKD |
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Treating the bone problem in CKD
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Restrict dietary phosphorus
Give VitD if phosphorus is normal |
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Consequences of increase Ca and PO4
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Precipitation in tissues
Calciphylaxsis |
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Metabolic acidosis in CKD
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When GFR is < 30
Results in increased protein catabolism and worsening bone disease Kidney can no longer get rid of the acid load from daily metabolism Give NaHCO3 or NaCitrate |
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Access for hemodialysis
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Arteriolize a vein by creating a fistuala
This gives good site for access Takes a few months to develop so plan ahead |
