Fek - 5-7 - Chronic Kidney Disease

Front 1

Main causes of CKD

Back 1

diabetes
HTN
glomerulonephritis

Front 2

Survival in ESRD

Back 2

very poot. worse than many cancers.

Front 3

Where more focus should be

Back 3

preventing the onset of chronic kidney disease

Front 4

Definition of CKD

Back 4

Kidney damage for >= 3 months. (shown by pathology, abnormal blood/urine, or imaging)

or GFR<60 for >= 3 months.

Front 5

When do sx present for CKD

Back 5

when far advanced in the kidney disease.

Front 6

Stages of CKD

Back 6

Based on GFR bc easy to relate to pts.

1 - > 90 with kidney damage
2 - 60-89
3 - 30-59
4 - 15-29
5 - <15 or on dialysis.


most people with CKD are in stage 4

Front 7

Is mild CKD a risk factor for death?

Back 7

yes

Front 8

CV disease and CKD

Back 8

both affect each other (vicious cycle).

Most pts die of CV disease before their kidney disease progresses to high stages.

Front 9

Mech of CV disease in CKD

Back 9

HTN, endothelial dysfunc, dyslipidemia, inflamm, oxidative stress, RAS, vascular calcification...

Front 10

Relationship btwn albumin and kidney disease

Back 10

albumin in urine is both a sign AND RISK of kidney disease. Lowering albumin excretion rate lowers risks.

albuminuria is a risk factor independent of GFR for CV disease.

Front 11

weird things that are risk factors for CKD

Back 11

race (black, NA, AA..), tobacco, low birthweight (less nephrons)

Front 12

Histo of progressive CKD

Back 12

tubular atrophy, interstitial fibrosis, glomerular sclerosis, periglomerular fibrosis.

Bx is useful early in disease to discern cause bc late in disease the histo of many causes all looks the same.

Front 13

factors of histo that correlate best with CKD progression

Back 13

tubular and interstitial changes

Front 14

things to screen for

Back 14

serum creat and GFR
BP
glucose
urinalysis
microalbuminuria/proteinura.

Front 15

with creatinine...

Back 15

make sure you get a gfr estimate as well!

(accounts for age, gender, race, etc.)

Front 16

when measuring proteinuria..

Back 16

measure protein/creatinine ratio

and the albumin/creatinine ratio

Front 17

who should be screened?

Back 17

people AT RISK for CKD (which is a lot of people...)

Front 18

comorbidities of CKD

Back 18

CVDisease
HTN
anemia
bone disease
metabolic acidosis (contrib to bone disease)
protein malnutrition

Front 19

BP control target

Back 19

<130/80

Use aceinh or arb first and add diuretic as second line.

then try beta blocker or ca channel blocker

reducing BP will bring the GFR back up.

Front 20

do aci inh work well in diabetics with CKD?

Back 20

yes!

Front 21

why do docs not use ace inhs?

Back 21

they fear a rise in creatinine. bc the efferent arteriole dilates so the glom capp pressure goes down. but if it is 10-20%, that is fine.

it will stabilize...

but if it doesn't, it is bc the GFR was dependent on that high capp pressure. then dropping the pressure would be a bad thing...

Front 22

avoid ___ in advanced CKD

Back 22

K+ supplements and K sparing agents bc is already in hyperkalemia (due to inc AG metabolic acidosis)

Front 23

what happens to hemoglobin with ckd?

Back 23

down

lower gfr leads to more anemia.

this is asoc with confusion, CV disease (angina, cardiac enlargement..), and poor QOL

this is bc renal mass goes down so less epo is made (and less anti-apoptosis and less erythro maturation).

Could use a recombinant but is easy to overcorrect and get CV complications.

Front 24

definition of anemia

Back 24

Men - <13.5
Women < 12


"anemia correction: Hb 11-12"

Front 25

what stage is anemia commonly seen?

Back 25

3

Front 26

Why does sec parathyroidism develop?

Back 26

phosphate retention and vit D def (less 1 alpha hydroxylase)

this leads to hypocalc as well and osteodystrophy.

and remember the chronic metab acidosis leads to phosphate buffering and thus bone loss (ossteopor whereas before it was osteomalacia)

Front 27

PTH rises as...

Back 27

gfr decreaes

Front 28

How to tx phosphorus retention

Back 28

diet restriction and phosphate binders.

also do vit d supps for hypocalc.

Front 29

Metab acidosis

Back 29

usually once GFR<30

leads to more muscle catab and bone disease.

Tx - NaHCO3 or NaCitrate

Front 30

things to do

Back 30

stop nsaids (incl cox-2 inh) bc potential for nephrotoxicity.

stop cigarettes

reduce protein, exercise

Front 31

when to consider dialysis

Back 31

creat > 4 and GFR<30 (stage 4)

but be careful of infection --> endocarditis

Front 32

slide 73

Back 32

this is what we should do. we only tx the kidney failure though...