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29 Cards in this Set
- Front
- Back
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What is chronic kidney disease?
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Conceptually, CKD is the persistent decline in GFR.
Specifically, CKD is a GFR <60mL/min that persists for greater than three months CKD can also be defined and diagnosed based on structural and functional defects in the kidney, such as in a patient with significant proteinuria but no change in creatinine clearance. |
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Describe two methods for calculating GFR.
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1) Creatinine clearance – requires 24-hour urine creatinine collection, then a spot sample of serum creatinine.
2) Equations – Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault formulas |
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What is staging of CKD based on?
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GFR
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How many stages of CKD are there?
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5
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What is “end-stage” renal disease?
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Stage 5 CKD
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At what stage of chronic kidney disease do clinical manifestations begin to appear?
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Stages 4 and 5
Stages 1 to 3 are usually asymptomatic |
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What is hyperfiltration?
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Compensatory maintenance of GFR via constriction of the efferent arteriole
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Give an overview of the pathogenesis of chronic kidney disease.
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1) Decrease in GFR due to some initial insult
2) Compensatory hyperfiltration and hypertrophy of residual nephrons 3) Scarring and fibrosis – glomerulosclerosis |
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What are the two most common causes of chronic kidney disease in North America?
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Diabetes and hypertension account for approximately 70% of cases.
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What percentage of total nephrons must be lost before the serum creatinine level become elevated?
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50% or more
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What are the two primary physiologic functions of the kidney?
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Regulation of volume status and clearance of physiologic toxins
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Describe the key elements of a focused history for a patient with chronic kidney disease.
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1) Symptoms of uremia: mental status changes, nausea/vomiting, pruritis, anorexia, or insomnia.
2) Symptoms of volume overload: orthopnea, PND, peripheral edema 3) Treatment for CKD: ACE/ARB, peritoneal/hemodialysis (and schedule), kidney transplant |
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Describe the key elements of a focused history for a patient with chronic kidney disease.
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1) Symptoms of uremia: mental status changes, nausea/vomiting, pruritis, anorexia, or insomnia.
2) Symptoms of volume overload: orthopnea, PND, peripheral edema 3) Treatment for CKD: ACE/ARB, peritoneal/hemodialysis (and schedule), kidney transplant |
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Name 2 signs of uremia you may find on physical examination.
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Asterixis, pericardial rub
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Patients with CKD are at increased risk of incurring kidney damage due to iodinated contrast dye used in CT scans. What strategy is used in these patients to prevent the damage if they MUST have contrast dye?
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IV fluid hydration prior to the test
N-acetylcysteine administration both before and after the test |
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The contrast dye used for MRI is gadolinium. This substance is less toxic than the dies used in CT but still presents a risk. What condition might Gadolinium cause, especially in a patient with poor renal function?
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Nephrogenic systemic fibrosis
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What two classes of medications are used to slow the progression of chronic kidney disease?
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ACE inhibitors
ARBs |
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What effect do ACE inhibitors/ARBs have on blood flow through the kidney?
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ACE-IS/ARBS REDUCE renal blood flow by blocking the effects of angiotensin II, which would under physiologic conditions constrict the efferent arteriole.
In other words, these medications cause the relaxation of the efferent arteriole and a decrease in pressure in the renal vasculature. In patients with hypovolemia this may put them at risk for acute renal failure, as the constriction of the efferent arteriole is part of a compensatory mechanism required to maintain GFR. In the long run, however, reducing pressure in this system decreases the damage caused by hypertension and fibrosis. |
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What effect might ACE inhibitors have on serum potassium?
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Increase in serum potassium.
Ultimately, ACE inhibitors block the release of aldosterone. Aldosterone normally causes reabsorption of Na+ and secretion of K+. Without this effect K+ secretion drops and serum K+ increases. |
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Name three non-pharmacologic treatments for chronic kidney disease.
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1) Peritoneal dialysis, 2) hemodialysis, 3) kidney transplant
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What is a hemodialysis patient’s “dry weight”?
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Weight after dialysis and fluid removal
Comparing the patient’s “dry weight” to his or her current weight will give you a good idea about his or her volume status. It is common for patients to gain 2-4 kg over the “dry weight” between sessions. |
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What is the number one cause of death amongst dialysis patients?
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Cardiac disease – take complaints of chest pain seriously!
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Name three methods of establishing access to the bloodstream for hemodialysis.
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Catheter, AV graft, AV fistula
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Give an advantage of AV fistula over AV graft.
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There’s no synthetic material, so the risk of infection is much less.
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What is the most common pathogen associated with infections of hemodialysis catheters?
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S. aureus
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What must you remember when prescribing medications to patients with chronic kidney disease?
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Dose-adjustment is require for medications that are cleared by the kidney
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Name 7 complications of chronic kidney disease.
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Recall that these clinical complications don’t often appear until at least stage 4.
1) Volume overload – pulmonary edema, heart failure, peripheral edema 2) Uremia – altered mental status, insomnia, pruritis, nausea/vomiting, anorexia 3) Secondary hyper-parathyroidism and bone disease 4) Anemia 5) Hyperphosphatemia 6) Hyperkalemia 7) Metabolic acidosis |
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Name 4 nutrients that should be restricted in the diet of a patient with CKD.
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Protein, salt, potassium, phosphorous
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What group of medications helps combat hyperphosphatemia?
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Phosphate binders
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