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46 Cards in this Set
- Front
- Back
Stage the kidney disease?
Kidney dmg with normal or increased GFR GFR>90 |
1
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Stage the kidney disease?
kidney damage with mild decrease in GFR GFR 60-89 |
2
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Stage the kidney disease?
Moderat decrease in GFR GFR 30-59 |
3
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Stage the kidney disease?
Severe decrease in GFR GFR 15-29 |
4
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Stage the kidney disease?
Kidney failure <15 |
5
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1st and second leading cause of ESRD?
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Diabetes
HTN |
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why is dialysis so prevalent in WV
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because we have a bunch of fatties with Diabetes and HTN
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define CKD
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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 |
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at what stage of kidney disease should you prepare for kidney replacement therapy?
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4
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What stage of kidney disease do you being to evaluate and treat complicatoins?
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3
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calcium and phosphorus changes will start to develop at what stage of CKD
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3
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major co-morbid condition with CKD?
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Cardiovascular Disease
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What is extremely important in treating someone with both diabetic and non-diabetic kidney disease? What can you do to achieve this?
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KEEPING THE BP LOW!!
ACE/ARB |
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what type of diet can increase the progression of kidney damage
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high protein
you do NOT want to use the Adkins diet |
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What are 2 important equational measurements of GFR
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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) |
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What are the pros/cons of the Cockcroft-Gault equation?
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Pros: Uses easily determined measures
(age, weight, creatinine, gender) Cons: Must use lean body weight (difficult to ascertain in older, obese or malnourished patients) |
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Gold standard for GFR measurement?
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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
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When do you want to use a 24 hour urine collection to estimate GFR?
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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 |
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what is the major blockage to protein's leaking?
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basement membrane
because of the negatively charged component (proteins are also neg charged) |
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Serum creatine levels of _____ are indicative of CKD
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1.5mg/dL or greater
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Patients with GFR < 60 ml/min should be evaluated for ?
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anemia
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Patients with GFR < 60 ml/min should undergo assessment of dietary ____ and _____
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protein and energy intake
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neuropathy can develop with
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CKD
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3 things have prvoen effectiveness in slowing of CKD progression...
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Strict glc control in DM
Strick BP control ACE or ARBs |
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T/F
a pt with declined GFR should undergo imaging studies including CT with contrast |
False!!
Avoid IV contrast |
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What ABX is strongly contraindicated with ppl who have declined GFR?
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aminoglycosides
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ppl with CKD are most likely to die from what?
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CVD or other diabetic complicatoins (rather than actually due to their kidneys)
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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 |
Stage 3
greater than 3 months and 30-59 |
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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 |
He has Stage 1 chronic kidney disease
because we KNOW he has some kidney disease and 95 mL per minute |
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CKD Stage 5 patients on Renal replacement therapy (RRTx)
= |
Stage 6
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Hemodialysis filters at what rate
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30 mLs/minute
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what are the 3 processes in hemodialysis
*** |
Diffusion
Convection Ultrafiltration |
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what is the basic mechanistic setup for hemodialysis
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high pressure system with surgically connected artery and vein
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what is the basis behind how hemodialysis works?
** |
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 |
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what is one of the major diff btw peritoneal dialysis and hemodialysis? (other than location of where it is administered)
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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) |
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in peritoneal dialysis, what osmotic agent is used? If you have lots of fluid, what % do you use... what about dehydration
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GLUCOSE
Lots of fluid: 3.86 dehydration: 1.36 |
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What has the greatest potential for restoring healthy productive life?
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Transplantation
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major limitation to expanding the use of transplantation?
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shortage of donors
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What is a Pre-emptive renal transplant
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getting a transplant before on dialysis but are for sure headed that way
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2 key things that make you a candidate for kidney transplant?
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Dialysis-dependent ESRD patients
CKD patients with GFR < 15 ml/min |
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which is better: living or cadaveric donor transplants
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if you got this wrong. please slap yourself
LIVING |
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what K imbalance will you get with ACEi
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hyperkalemia
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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 |
All of the above
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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 |
Living-related transplant
PERFECT MATCH! Best possible! |
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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?
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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 |
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when is a 24 hour urine collection indicated?
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for people with abnormal lean body mass (aka old people or fatties)
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