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31 Cards in this Set
- Front
- Back
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How is CKD defined?
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Pathologic abnormalities, or
Markers of kidney damage, such as abnormalities of the blood or urine, or in imaging tests (but NOT HTN). |
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How is CKD defined via GFR lab value?
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GFR < 60 mL/min/1.73 m2 for ≥ 3 months with or without kidney damage.
Normal GFR varies according to age, sex, and body size; in young adults it is approximately 120 to 130 mL/min/1.73 m2 and declines with age. A decrease in GFR precedes the onset of kidney failure; |
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What are 4 markers of kidney damage?
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Proteinuria
Microalbuminuria Hematuria (especially when seen with proteinuria) Isolated hematuria has a long differential: infection, stone, malignancy, etc. Casts (especially with cellular elements) |
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What is the description, GFR and Action of stage 1 kidney disease?
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kidney damage with normal or increased GFR
90 Diagnosis and treatment, treatment of comorbid conditions, slowing of progression, and cardiovascular disease risk reduction |
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What is the description, GFR and Action of stage 2 kidney disease?
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Kidney damage with mildly decreased GFR
60-89 Estimation of progression |
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What are susceptibility Risk Factors?
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Advanced age
Reduced Kidney mass African American Family history Low income or education Systemic inflammation dyslipidemia |
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What are initiation risk factors?
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DM
HTN glomerulonephritis |
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What are progression risk factors?
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Glycemia
HTN Proteinuria Smoking Obesity |
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What is the life expectancy in dialysis patients?
The primary cause of death in ESRD patients is what? What are strong predictors of mortality in the dialysis population? |
Life expectancy is four to five times shorter in dialysis patients than in the general population.
The primary causes of death in the ESRD population are cardiovascular diseases and infection Comorbidities, estimated GFR, and albumin at initiation of dialysis are strong predictors of mortality in the dialysis population. |
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What 1 thing may contribute to the progressive decline in kidney function?
Loss of kidney function is usually ____ |
Proteinuria, one of the initial diagnostic signs, may also contribute to the progressive decline in kidney function. Loss of kidney function is usually irreversible.
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What one sign/symptom indicates proteinuria?
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foaming of urine
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What is a common Etiology that results in CKD?
What are common etiologies for ckd in diabetics? What are signs and symptoms associated with fluid and electrolyte abnormalities? |
increased bp
hyperglycemia and glucosuria hyperkalemia and fluid overload |
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What are 4 developments of secondary complication of CKD?
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Anemia: Decreased hemoglobin and hematocrit, iron deficiency common
CKD mineral and bone disorder: Increased serum phosphorus, decreased serum calcium (at risk for hypercalcemia as kidney disease progresses), increased intact parathyroid hormone (iPTH), and vitamin D deficiency Metabolic acidosis: Decreased serum bicarbonate and increased anion gap Malnutrition: Decreased albumin and prealbumin |
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What stages of CKD is there a vit D deficency?
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Stages 3 and 4
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What does increased iPTH promote?
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Decreased phosphorus reabsorption within the kidney
Increased calcium reabsorption by the kidney Increased calcium mobilization from bone |
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As kidney disease progresse, what 4 components occur?
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1.Hyperphosphatemia and subsequent hypocalcemia progressively worsen, and secondary hyperparathyroidism becomes more severe.
2.The renal effects of PTH on phosphorus and calcium are no longer maintained, and PTH predominantly stimulates calcium resorption from bone. 3.Decreased production of active vitamin D worsens hypocalcemia and secondary hyperparathyroidism. In more severe CKD (stages 4 and 5), patients are prone to develop hypercalcemia, in part because of the use of calcium-containing phosphate binders. Patients with stage 5 CKD are at risk for calcifications and calciphylaxis. 4.Uncontrolled secondary hyperparathyroidism leads to hyperplasia of the parathyroid gland and renal osteodystrophy (from sustained effects of iPTH on bone). |
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What is Metabolic acidosis defined as?
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Decreased excretion of acid by the kidney
Accumulation of endogenous acids attributable to impaired kidney function (e.g., phosphates and sulfates) |
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What stage does malnutrition develop in?
When assesment needs to be made? |
Usually develops starting in stage 3 patients
Dietary assessment for protein calorie intake serum albumin |
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When there is a progressive increase in scr what must be considered?
When there is a decrease in GFR what assessment methods should be considered? |
serum creatinine: > 1.1–1.2 mg/dL for females and > 1.2–1.3 mg/dL for males. Consider factors that may alter serum creatinine, such as decreased muscle mass and nutritional status
Measured creatinine clearance Cockcroft–Gault equation Modification of diet in renal disease abbreviated equation |
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By looking at which abnormal serum chemistries can you diagnosis if its Microalbuminuria, albuminuria, or clinical proteinuria?
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Increased serum creatinine (0.6-1.2) and BUN (8-18)
Increased potassium (3.5-5), decreased serum bicarbonate (22-28), increased phosphorus (2.5-5), and decreased calcium (8.8-10.2 total) (unbound 4.6-5.2)(indicative of secondary complications) |
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What risk factos should we really pay attention to when screening for chronic kidney disease?
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Diabetes
Hypertension Family history of chronic kidneydiseases US ethnic minority status: black, indians, hispanics, asian or pacific island |
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When evaluating for patients for chronic kidney disease, what tests should be run?
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Measure BP
Serum Creatine to estimate GFR Protein to creatinine ratio or albumin to creatinine ratio in a first morning or random untimed spot uring specimen |
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What factors increase Scr concentrations?
What factors decrease it? |
Kidney Disease
Ketoacidosis Ingestion of cooked meat Drugs: Trimethoprim (trimadex, proloprim) Cimetidine (tagmet) Flucytosine (ancobon) Some cephalosporins Ruduced Muscle Mass Malnutrition |
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What does the MDRD equation estimate?
What does the Cockcroft-Gault equation estimate? |
The MDRD equation estimates GFR.
eGFR is given per 1.73m2 BSA The Cockcroft-Gault equation estimates CrCl. CrCl is best used for drug dosing decisions--drug dosing is usually indexed to CrCl. |
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What is the number 1 rand 2 risk factors for ckd?
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DM
HPN |
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Guidelines for anemia management in patients with CKD recommend further evaluation for anemia when hemoglobin is what?
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is < 12 g/dL in females and < 13.5 g/dL in males.
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For iron deficiency what must be evaluated?
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For iron deficiency, evaluate red blood cell indices and iron indices to identify iron deficiency as a contributing factor; iron deficiency manifests as a microcytic anemia.
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What do you do when evaluating cause in iron deficiency?
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In post-menopausal females and males you have to evaluate for GI blood loss.
In menstruating females, menses is a common cause; the most common cause of anemia overall in females. |
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How do you treat Iron deficiency?
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Iron replacement can typically be given orally, ferrous sulfate or gluconate 325 mg, 1-3 times a day
Sulfate salt is cheaper but generally less well tolerated |
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During Iron therapy, what SEs may lead to low compliance?
What enhances absorption of Fe? When should HCT improve, and how long should therapy be continued for? |
Side effects of oral iron replacement lead to low compliance.
Constipation, stomach upset May have less symptoms if they take it with food (though this decreases absorption) Vitamin C enhances absorption Expect Hct to improve within a few weeks of therapy though pts should continue treatment for 6 mo -1 yr, would like to see ferritin level normalized |
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Hot to diagnosis Metabolic Acidosis?
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Serum bicarbonate (HCO3–) is < 20 mEq/L.
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