Johns Hopkins Chapter 35 - Ckd Esrd

Front 1

define CKD

Back 1

structural or functional abnormalities of the kidney for 3 months or longer, +/- decreased GFR

Front 2

normal GFR

Back 2

≥90 mL/min/1.73 m2

Front 3

NKD Stage I CKD

Back 3

Kidney damage (proteinuria, cyst formation, etc.) with normal or increased GFR

Front 4

stage II CKD

Back 4

Kidney damage with mild decrease in GFR (GFR 60–89 mL/min/1.73 m2)

Front 5

Stage III CKD

Back 5

Moderate decrease in GFR (GFR 30–59 mL/min/1.73 m2)

Front 6

Stage IV CKD

Back 6

Severe decrease in GFR (GFR 15–29 mL/min/1.73 m2)

Front 7

Stage V CKD

Back 7

Kidney failure (GFR 15 mL/min/1.73 m2 or dialysis)

Front 8

usual indication for initiation of dialysis

Back 8

Onset of symptoms

Front 9

early symptoms of CKD (4)

Back 9

anorexia, nausea, lethargy, fatigue

Front 10

late symptoms of CKD (5)

Back 10

pruritis, encephalopathy, volume overload, chest pain (pericarditis), neuropathy

Front 11

metabolic abnormalities in CKD

Back 11

anemia, acidosis, hyperkalemia, hyperPTH

Front 12

hyperparathyroidism is associated with these abnormalities

Back 12

hypocalcemia, hyperphosphatemia, metabolic bone disease

Front 13

PE findings of CKD (6)

Back 13

uremic fetor, pallor, friction rub, vol overload, asterixis, calciphylaxis

Front 14

Calcification of arterioles seen in ESRD (not just CKD)

Back 14

Calciphylaxis, AKA calcific uremic arteriolopathy

Front 15

where does calciphylaxis usually occur?

Back 15

lower extremities and trunk

Front 16

how to assess iron status in CKD?

Back 16

Inadequate iron stores if ferritin <100, TSAT <20%

Front 17

mechanism of metabolic bone disease in CKD

Back 17

low 1,25 dihydroxyvitamin D, high phosphate, low calcium, hyper PTH --> renal osteodystrophy

Front 18

goal iPTH in CKD (in general)

Back 18

1.5–2x upper limit of normal

Front 19

K/DOQI goals for iPTH in CKD

Back 19

CKD III: 35–70 pg/mL; CKD IV: 70–110 pg/mL; CKD V or ESRD: 150–300 pg/mL

Front 20

K/DOQI goals for serum phosphorus in CKD

Back 20

2.7–4.6 mg/dL (CKD III, IV); 3.5–5.5 mg/dL (CKD V or ESRD)

Front 21

phosphate binders (3)

Back 21

calcium carbonate/acetate; sevelamer, lanthanum carbonate

Front 22

goal serum bicarbonate in CKD

Back 22

>22 mEq/L

Front 23

when to start bicarbonate therapy in CKD

Back 23

<18 mEg/L

Front 24

this equation improves GFR estimation compared with MDRD equation in those with GFR above 60 mL/min/1.73 m2

Back 24

CKD epidemiology collaboration (CKD-EPI)

Front 25

features that indicate CKD (3)

Back 25

old crea levels (>3mos); small kidneys on US; manifestations of CKD (anemia, hyperPTH, acidosis)

Front 26

normal kidney size

Back 26

10 to 12 cm

Front 27

when is nephrology referral indicated in CKD

Back 27

all patients with GFR <30; rapid decline (>15 / year); unexplained proteinuria or hematuria suggestive of glomerulonephritis

Front 28

MOA of ACE and ARBs in CKD

Back 28

Decrease intraglomerular pressure and hyperfiltration

Front 29

beta blockers and CKD - which one to use?

Back 29

Atenolol is cleared by the kidney; consider switch to hepatically cleared metoprolol

Front 30

dietary protein in CKD - what is the recommendation?

Back 30

Maximum dietary restriction is 0.7 g of protein/kg of body weight/day; suggest 1 g of protein/kg of body weight/day

Front 31

Goal hemoglobin A1c in CKD

Back 31

6%

Front 32

when is gadolinium contrast contraindicated in CKD?

Back 32

GFR less than 30; —if its use is essential in this high-risk group, use a low dose of a macrocyclic (more stable) agent (gadoteridol)

Front 33

how to give N-acetylcysteine to reduce risk of ARF in patients to be given radiocontrast

Back 33

600 mg BID x 24 hours before and 48 hours after procedure

Front 34

when to refer CKD patients to transplantation center for evaluation?

Back 34

when GFR <30ml/min

Front 35

when are CKD patients listed for deceased donor transplant?

Back 35

when GFR <20ml/min

Front 36

when to initiate dialysis (based on GFR)

Back 36

DM - <15; nonDM - <10

Front 37

absolute dialysis indications

Back 37

Acidosis despite medical management, uremic Enceph, Intractable hyperkalemia, volume Overload not responsive to diuretics, Uremic pericarditis

Front 38

most common cause of death in dialysis patients

Back 38

Heart disease (usually sudden cardiac death), followed by infection

Front 39

when is PD catheter placed?

Back 39

4 to 6 weeks before initiation of therapy

Front 40

maturation time for AVF

Back 40

2 to 8 months

Front 41

when to refer CKD patient to vascular surgeon for access?

Back 41

6-12 months before anticipated need for dialysis

Front 42

which arm to use for phlebotomy and BP measurement?

Back 42

dominant arm; preferably hand veins

Front 43

side effect of using metformin in CKD patients

Back 43

lactic acidosis (mitochondrial toxicity)

Front 44

side effect of using meperidine in CKD patients

Back 44

seizure (low clearance of toxic metabolite normeperidine)

Front 45

side effect of using sucralfate in CKD patients

Back 45

aluminum toxicity (high aluminum content, with decreased clearance in renal failure)

Front 46

side effect of using atenolol in CKD patients

Back 46

bradycardia (dec renal clearance)

Front 47

side effect of using gabapentin in CKD patients

Back 47

AMS, other CNS toxicities (dec renal clearance)