Ipapburke Gu Test 1- Ckd

Front 1

Essentials of diagnosis for CKD

Back 1

progressive azotemia over months/years; S/S uremia when nearing ESD; HTN; isothenuria and broad, waxy casts in urinary sediment, bilateral small kidneys on US

Front 2

Definition of CKD

Back 2

evidence of renal damage based on abnormal UA or structural abnormalities OR GFR < 60 ml/min for 3+ mths

Front 3

Most common RF for CKD

Back 3

DM, HTN, CAD, Family History of CKD, age over 60

Front 4

What does reduction in renal mass lead to in CKD?

Back 4

hypertrophy of remaining nephrons with hyperfiltration (GFR is transient supranormal); the remaining nephrons are burdened and sclerose and fibrose worsening the failure

Front 5

Manifestations of far advanced renal failure

Back 5

fatigue, malaise, weakness, pruritis

Front 6

Gig complaints in renal failure

Back 6

anorexia, N/V, metallic taste, hiccups

Front 7

Describe symptom progression In CKD

Back 7

slow developing and nonspecific symptoms; patients are asymptomatic often until GFR less than 15

Front 8

neurologic problems caused by CKD

Back 8

irritability, difficulty concentrating, insomnia, forgetfulness

Front 9

Reproductive/Genital symptoms of CKD

Back 9

menstrual irregularities, infertility, loss of libido

Front 10

What are Mee's lines?

Back 10

nail changes found in CKD

Front 11

What is uremic fetor?

Back 11

fishy breath in CKD

Front 12

What skin changes are there in CKD?

Back 12

yellow with easy bruising, pruritis

Front 13

How is diagnosis of CKD made?

Back 13

documenting elevations of BUN and serum creatinine concentrations

Front 14

Once the GFR drops below 60, what should be done?

Back 14

refer to nephrologist

Front 15

What is suggestive of CKD even in the absence of reduced GFR?

Back 15

persistent protienuria

Front 16

What is seen on UA of CKD?

Back 16

broad, waxy casts (the tubules have lost their concentrating ability)

Front 17

Electrolyte changes that may be seen in CKD

Back 17

hyperphosphatemia, hypocalcemia, hyperkalemia

Front 18

Finding of small echogenic kidneys on ultrasound supports what diagnosis?

Back 18

CKD or irreversible disease

Front 19

What X ray finding may help to diagnose CKD?

Back 19

renal osteodystrophy (check phalanges of hands and clavicles)

Front 20

What uremic complication causes over half of deaths in CKD?

Back 20

Cardiovascular disease

Front 21

MC complication of CKD

Back 21

HTN

Front 22

What causes most of the acid base disorders in chronic kidney disease?

Back 22

tend to retain H ions

Front 23

What is considered a small kidney?

Back 23

less than 9 cm

Front 24

Normal size of kidney

Back 24

10-12 cm in adult

Front 25

How do you treat HTN in patient with CKD?

Back 25

weight loss, tobacco sensation, reduce salt intake to 2 g/day or less, ACE- I or ARB, and SMOKING CESSATION

Front 26

BP goal in CKD

Back 26

less than 130/80; if protienuria greater than 1-2 g/day, the goal is 125/75

Front 27

What is the BP goal for patient with protienuria in CKD?

Back 27

125/75

Front 28

What is the cause of pericarditis in CKD?

Back 28

retention of metabolic waste

Front 29

Symptoms of endocarditis

Back 29

chest pain and fever; maybe pulsus paradoxus or friction rub on exam

Front 30

Pericarditis is an absolute indication for initiation of _____________.

Back 30

dialysis

Front 31

How should you treat CHF in patient with CKD?

Back 31

loop diuretic, ACE-I, and regulation of salt and water

Front 32

Patients with ESRD have a ________ cardiac output along with HTN and atherosclerosis that increase LVK and dilation.

Back 32

high

Front 33

The potassium balance usually remains intact until the GFR is below what?

Back 33

10-20 ml/min

Front 34

What is included for tx of hyperkalemia?

Back 34

cardiac monitoring, IV calcium chloride or glutanate, insulin with glucose, bicarb, and sodium polystrene sulfonate

Front 35

What is used to treat chronic hyperkalemia?

Back 35

dietary potassium restriction and sodium polystrene PRN

Front 36

pH that is absolute for initiation of dialysis

Back 36

below 7.2

Front 37

What is metabolic acidosis in CKD usually a result of?

Back 37

loss of renal mass so kidneys cannot excrete the acid produced daily by the body

Front 38

Tx for metabolic acidosis?

Back 38

maintain serum bicard above 21

Front 39

What is anemia in CKD caused by?

Back 39

decreased erythropoeisis and RBC survival

Front 40

Main cause of coagulopthy in CKD

Back 40

platelt dysfunction

Front 41

Progression of uremic encephalopathy in CKD

Back 41

GFR drops below 10-15; difficulty concentrating --> lethargy --> confusion --> coma

Front 42

What is renal dystrophy a disorder of?

Back 42

calcium, phosphorous, and bone

Front 43

MC disorder of mineral metabolism

Back 43

osteitis fibrose cystica- bony changes secondary to hyperparathyroidism

Front 44

Where are renal bone lesions most commonly found?

Back 44

phalanges of fingers and lateral ends of clavicles

Front 45

Why are circulating insulin levels increased in CKD?

Back 45

decreased renal insulin clearance

Front 46

What is the cause of glucose intolerance in CKD?

Back 46

peripheral insulin resistance

Front 47

Tx for CKD in general

Back 47

stop smoking, ACE/ARB to slow protienuria and CVD, Diabets control, lower cholesterol w/ statin, avoid fluid overload w/ Lasix, CKD clinic involvement

Front 48

Why should every CKD patient see dietician?

Back 48

malnutrition is commonl; also need protein, salt/water, potassium, phosphorous, and magnesium restriction

Front 49

In general protein intake should not exceed what amount daily?

Back 49

1 g/kg/day

Front 50

In general what is the initial recommendation for salt restriction?

Back 50

2 g/d or less

Front 51

What GFR and serum creatinine should you start dialysis at?

Back 51

under 10 ml/min and 6 mg/dl

Front 52

What GFR do diabetics start dialysis at?

Back 52

under 15 ml/min

Front 53

How is vascular access accompished in hemodialysis?

Back 53

preferred AV fistula, but also prosthetic graft

Front 54

MC cause of infection in dialysis patients

Back 54

Staph Aureus

Front 55

MC type of dialysis

Back 55

hemodialysis

Front 56

MC PD complication

Back 56

peritonitis (Staph Aureus)

Front 57

MC type of Peritoneal Dialysis

Back 57

continuous ambulatory peritoneal dialysis

Front 58

Infection, thrombosis, and aneurysm formation are comlications found more in (AV fistula or graft) used in dialysis? Choose

Back 58

graft

Front 59

MC cause of death in CKD

Back 59

cardiac dysfunction