Renal: 32. Schmidt : Care Of Chronic Renal Failure Pt

Front 1

Stage the kidney disease?

Kidney dmg with normal or increased GFR

GFR>90

Back 1

1

Front 2

Stage the kidney disease?

kidney damage with mild decrease in GFR

GFR 60-89

Back 2

2

Front 3

Stage the kidney disease?

Moderat decrease in GFR

GFR 30-59

Back 3

3

Front 4

Stage the kidney disease?

Severe decrease in GFR

GFR 15-29

Back 4

4

Front 5

Stage the kidney disease?

Kidney failure

<15

Back 5

5

Front 6

1st and second leading cause of ESRD?

Back 6

Diabetes

HTN

Front 7

why is dialysis so prevalent in WV

Back 7

because we have a bunch of fatties with Diabetes and HTN

Front 8

define CKD

Back 8

GFR<60 ml/min for greater than 3 months with or without kidney damage

OR

Kidney damage for >3 months with or without decreased GFR, manifested by either pathological abnormalities or markers of kindney damage

Front 9

at what stage of kidney disease should you prepare for kidney replacement therapy?

Back 9

4

Front 10

What stage of kidney disease do you being to evaluate and treat complicatoins?

Back 10

3

Front 11

calcium and phosphorus changes will start to develop at what stage of CKD

Back 11

3

Front 12

major co-morbid condition with CKD?

Back 12

Cardiovascular Disease

Front 13

What is extremely important in treating someone with both diabetic and non-diabetic kidney disease? What can you do to achieve this?

Back 13

KEEPING THE BP LOW!!

ACE/ARB

Front 14

what type of diet can increase the progression of kidney damage

Back 14

high protein

you do NOT want to use the Adkins diet

Front 15

What are 2 important equational measurements of GFR

Back 15

Should be based on calibrated serum creatinine and formulae such as:

Cockcroft-Gault or the MDRD Study equation

MDRD equation provides a more accurate estimate of GFR than other equations.
(Modification of Diet in Renal Disease)

Front 16

What are the pros/cons of the Cockcroft-Gault equation?

Back 16

Pros: Uses easily determined measures
(age, weight, creatinine, gender)

Cons: Must use lean body weight (difficult to ascertain in older, obese or malnourished patients)

Front 17

Gold standard for GFR measurement?

Back 17

Since the creatinine clearance tends to overestimate the GFR and urea clearance tends to underestimate the GFR, we use the arithmetic mean of these two measurements to most accurately assess the GFR

Front 18

When do you want to use a 24 hour urine collection to estimate GFR?

Back 18

if the calculations (MDRD or Cockcroft-Gault) don't make sense

or Normal or near-normal renal function
Children
Extremes of body weight
Pts older than 70 years of age
Other ethnic groups, pregnant woman
Those with unusual muscle mass, body habitus, and weight

Front 19

what is the major blockage to protein's leaking?

Back 19

basement membrane

because of the negatively charged component (proteins are also neg charged)

Front 20

Serum creatine levels of _____ are indicative of CKD

Back 20

1.5mg/dL or greater

Front 21

Patients with GFR < 60 ml/min should be evaluated for ?

Back 21

anemia

Front 22

Patients with GFR < 60 ml/min should undergo assessment of dietary ____ and _____

Back 22

protein and energy intake

Front 23

neuropathy can develop with

Back 23

CKD

Front 24

3 things have prvoen effectiveness in slowing of CKD progression...

Back 24

Strict glc control in DM
Strick BP control
ACE or ARBs

Front 25

T/F

a pt with declined GFR should undergo imaging studies including CT with contrast

Back 25

False!!

Avoid IV contrast

Front 26

What ABX is strongly contraindicated with ppl who have declined GFR?

Back 26

aminoglycosides

Front 27

ppl with CKD are most likely to die from what?

Back 27

CVD or other diabetic complicatoins (rather than actually due to their kidneys)

Front 28

A 72 year old woman presents with an eGFR of 45 ml/min. Old records indicate that her eGFR was 50 m/min when checked the previous year. Chronic kidney disease is diagnosed at which stage:

Stage 1
Stage 2
Stage 3
Stage 4
Stage 5

Back 28

Stage 3


greater than 3 months and 30-59

Front 29

A 25 year old man is diagnosed with hereditary nephritis and has an GFR of 95 ml/min. Which of the following statements is correct?
He has Stage 1 chronic kidney disease

He does not have chronic kidney disease

He has Stage 4 chronic kidney disease

He has end stage kidney disease

He needs renal replacement therapy

Back 29

He has Stage 1 chronic kidney disease

because we KNOW he has some kidney disease and 95 mL per minute

Front 30

CKD Stage 5 patients on Renal replacement therapy (RRTx)
=

Back 30

Stage 6

Front 31

Hemodialysis filters at what rate

Back 31

30 mLs/minute

Front 32

what are the 3 processes in hemodialysis

***

Back 32

Diffusion
Convection
Ultrafiltration

Front 33

what is the basic mechanistic setup for hemodialysis

Back 33

high pressure system with surgically connected artery and vein

Front 34

what is the basis behind how hemodialysis works?

**

Back 34

the reason this works because you have the blood and fluid going in different directions (countercurrent flow) allowing for maintenance of the osmolar gradient

this optimizes solute clearance

Front 35

what is one of the major diff btw peritoneal dialysis and hemodialysis? (other than location of where it is administered)

Back 35

Peritoneal will allow the blood to be filtered by the kidney (what it can do) for just a little longer

which can help with filtration (Better preserved renal function)

Front 36

in peritoneal dialysis, what osmotic agent is used? If you have lots of fluid, what % do you use... what about dehydration

Back 36

GLUCOSE

Lots of fluid: 3.86

dehydration: 1.36

Front 37

What has the greatest potential for restoring healthy productive life?

Back 37

Transplantation

Front 38

major limitation to expanding the use of transplantation?

Back 38

shortage of donors

Front 39

What is a Pre-emptive renal transplant

Back 39

getting a transplant before on dialysis but are for sure headed that way

Front 40

2 key things that make you a candidate for kidney transplant?

Back 40

Dialysis-dependent ESRD patients

CKD patients with GFR < 15 ml/min

Front 41

which is better: living or cadaveric donor transplants

Back 41

if you got this wrong. please slap yourself

LIVING

Front 42

what K imbalance will you get with ACEi

Back 42

hyperkalemia

Front 43

A 62 year old man with CKD Stage 5 from diabetic nephropathy is contemplating renal replacement therapy. Which of the following might be options for this patient?
Peritoneal dialysis
Hemodialysis
Transplantation
Any of the above

Back 43

All of the above

Front 44

A 25 year old patient with Stage 4 CKD from chronic glomerulonephritis has a twin sibling offering to donate a kidney. This type of kidney transplant is known as a:
Living-related transplant
Deceased donor transplant
Presumptuous transplant

Back 44

Living-related transplant

PERFECT MATCH! Best possible!

Front 45

MDRD is good for showing that you have better than 60 GFR but can't tell you how good it is beyond this...because of this fact it is not good for accessing people with what stage kidney disease?

Back 45

1 and 2... because you might expect these people to have over 60, so you can't really tell exactly what their GFR is.

So if a healthy person did a MDRD you would see that they have a >60 GFR, but that is bad for a healthy person, it wouldn't tell you that they actually have 120

Front 46

when is a 24 hour urine collection indicated?

Back 46

for people with abnormal lean body mass (aka old people or fatties)