Therapeutics I - Test 2

Front 1

What is chronic kidney disease also referred to as?

Back 1

CKI- chronic kidney insufficiency

Front 2

How do you define this?

Back 2

kidney damage or kidney function decreased (decreased GFR) for 3 mo or more

Front 3

What can CKD lead to?

Back 3

ESRD

Front 4

Define ESRD?

Back 4

when kidney function is insufficient to sustain life

Front 5

What is needed?

Back 5

hemodialysis, peritoneal dialysis, or kidney transplant is substituted

Front 6

What are some of the suseptibility factors of CKD?

Back 6

age, decreased kidney mass, low birth weight, systemic inflammation, dyslipidemia, family history of CKD, racial/ehtnic minority, low income or eduction

Front 7

What are some initation factors?

Back 7

diabetes, hypertension, autoimmune disease, polyscystic kidney disease, drug toxicity

Front 8

What are some of the progression factors?

Back 8

poor glucose, blood pressure, proteinuria, smoking

Front 9

What plays a major role in progression of CKD?

Back 9

angiotensin II

Front 10

What happens to nephrons?

Back 10

to meet excretory demands, remaining nephrons undergo adaptations that increase single nephron GFR

Front 11

What is the most prominent change?

Back 11

glomerular hemodynamic adaptations (glomerular capillary htn)

Front 12

What does this lead to?

Back 12

glomerular sclerosis, neophron death

Front 13

How is glomerular htn maintained?

Back 13

primarily by angiotensin mehcanisms (increase BP, vasoconstriction of efferent arterioles)

Front 14

what else does angiotensin have?

Back 14

non-hemodyanmic effects that are important in progression of CKD

Front 15

What symptoms do you see in stage 1-2?

Back 15

non-absent

Front 16

What happes in stage 3-4?

Back 16

symptomatic, electrolyte disturbances, symp anemia

Front 17

What are classic symptoms with stage 5?

Back 17

pruritis, dysgeusia, nausea, vomiting, bleeding abnormalities

Front 18

what are symptoms of anemia?

Back 18

cold intolerance, sob, fatigue

Front 19

What is the severity of the symtpoms related to?

Back 19

rate of anemia development and the degree of hemoglobin reduction

Front 20

Describe stage 1?

Back 20

kidney damage , normal GFR >90

Front 21

stage 2

Back 21

kidney damage, mild decrease GFR 60-89

Front 22

stage 3

Back 22

moderate decrease GFR 30-59

Front 23

stage 4

Back 23

sever decrease gFR 15-29

Front 24

stage 5

Back 24

kidney failure <15 (on dialysis)

Front 25

What can slow the progression of renal failure?

Back 25

acei, arb

Front 26

When does the protective effect have the greatest impact?

Back 26

if initiated early, 1,2 females, 1.5 males, GFR<60

Front 27

What happens if you wait till the disease progresses?

Back 27

the likelihood of success decreases

Front 28

Who should be treated with ace regarldess of htn?

Back 28

people with CKD and proteinuria

Front 29

Who were ace shown to be more effective in?

Back 29

type 1 diabetes

Front 30

Who were arbs shown to be more effective?

Back 30

type 2 diabetes

Front 31

what type of doses should be used?

Back 31

moderate to high

Front 32

What should be monitored?

Back 32

blood pressure, serum creatinine, serum K

Front 33

When?

Back 33

1-2 weeks after initiations of therapy with ace

Front 34

What is the target total protein to creatinine?

Back 34

<500-1000 mg/g

Front 35

Who should use combo?

Back 35

lower bp or reduce proteinuria--safe and results in a great decrease in protein

Front 36

What is a major risk for development and progression of CKD?

Back 36

hyptertension

Front 37

What else can it worsen?

Back 37

cardivovascular disease in CKD

Front 38

What are the goals in hypertensive therapy?

Back 38

lower BP, slow progession of kidney disease, and reduce CVD risk

Front 39

What should be used to tx the hypertension?

Back 39

ACEI, ARB

Front 40

What will most patients require?

Back 40

tx with more than 1 drug

Front 41

What should you use if you max out ace/arb?

Back 41

diuretic, CCB, beta blcoker

Front 42

when should you use a thiazide/loop?

Back 42

thiazide if GFR>30, loop GFR<30, K sparing used with CAUTION

Front 43

Which calcium channel blockers should be used?

Back 43

verapamil, diltiazem -nondihydropyridine

Front 44

what does glycemic control depend on?

Back 44

stage at which it is begun, and degree of normalization of glucose metabolism

Front 45

what did tight glycemic control do?

Back 45

reduced incidence of microalbuminuria and albuminuria

Front 46

What is contreversial?

Back 46

dietary protein restriction

Front 47

What is wrong with this?

Back 47

compliance is difficult

Front 48

what is the recommended for GFR <25?

Back 48

0.6g/kg/day

Front 49

What if they have problems with nutrition?

Back 49

0.75 g/kg/day

Front 50

What is the goal of hyperlipidemia tx?

Back 50

to reduce risk for progressive cardiovascular dsiease

Front 51

What is the secondary goal of tx?

Back 51

reduction in protein and renal fucntion decline

Front 52

What is the goal LDL?

Back 52

<100 mg/dl in patietns with CKD

Front 53

What has smoking cessation shown?

Back 53

smoking is associated with faster rate of progression

Front 54

What does smoking cessation result in?

Back 54

protective effect against protien and reduced GFR

Front 55

What is a risk factor of chronic renal dysfunction to ESRD?

Back 55

anemia

Front 56

What might worsen CKD progression?

Back 56

hypoxia

Front 57

What might be beneficial?

Back 57

decreasing hypoxia by correcting anemia may be beneficial

Front 58

What is the goal of protein?

Back 58

<.5g/day

Front 59

what is the goal of GFR?

Back 59

<2 ml/min/y

Front 60

What is the goal bp?

Back 60

<130/80

Front 61

What is the dietary protein resitriction?

Back 61

0.6 g/kg/day- 0.75

Front 62

What is the goal hga1c?

Back 62

6.50%

Front 63

What is the goal LDL?

Back 63

<100