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22 Cards in this Set
- Front
- Back
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Is Chronic Kidney Dz (CKD) more common in AA or Caucasians?
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AA.
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What is the first step in evaluation of those with CKD?
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PE + Ultrasound (US)
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What happens to FE(Na) in CKD?
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it can reset to a new, higher baseline. Thus lvls for deducing other dx via this value must be adjusted accordingly.
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Ability of the pt to concentrate their urine improves/gets worse as GFR falls in worsening CKD.
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gets worse.
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What happens to acid-base metabolism in CKD?
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as GFR falls below 40, serum biCarb will start to fall b/c of decreased ammoniagenesis. The anion gap will rise as it gets below 10-15.
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What is CKD a CV dz risk factor?
What is the leading cause of death in ESRD pts? |
- oxidative state of blood is increased
- calcification of vasculature due to elevated phosphorus, maybe CV dz. |
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What is microalbuminuria re: CKD, how is it defined based on lab values, and what can in herald?
How can it be detected? |
>30mg in 24hrs of albumin excreted.
- 30-300mg = microalbuminuria worsening sx/mortality. Needs a special assay, not a normal urine dipstick. |
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ACS in CKD pts: how does it present?
What do cardiac troponin and creatinine kinase do as GFR falls? Which elevations have the greatest predictive value for myocardial injury in pts w/ CKD? |
atypically.
-- more likely to present with cardiogenic shock -- SOB elevate, even in the absence of Myocardial injurty Serial rises in CK-MB and cardiac troponin I |
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Is CHF more common in CKD pts?
Anemia? Why or why not? - tx? If the Hb is raised above ___ prog is decreased. Watch out! |
yes.
y/ in stage IV and V CKD. - decreased EPO production - can tx with EPO / DPO injections. 13 |
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What causes High phos and low calcium in CKD? High phos and low calcium stim what hormone? What does it do?
Should we tx with calcium? |
\Renal mass & decrease in D production
PTH --> bone reabs. No, it can elevated calcium levels and lead to vascular calcification. |
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Name the renal bone dz:
Low Turnover Mineralization decreased low PTH |
Adynamic bone dz
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Name the renal bone dz:
High turnover ^^reabs, ^formation HIGH PTH proximal myopathy ^ alk phos "Rugger Jersey" spine subperiosteal reabs How do you tx this dz? |
Osteitis fibrosa cystica
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What is the most common cause of renal bone dz? Characteristics?
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Mixed uremic osteodystrophy
- mix of Adynamic & OFC |
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What is Cinacalcet? what does it do?
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Drug used to help secondary overactive parathyroid fx.
- sensitizes calcium receptor to calcium. |
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What is the first thing that should be done to tx BMD in ESRD?
Should Vitamin D be used in BMD w/ ESRD? |
treat the excess phosphorus with non-calcium based binders.
only cautiously. |
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What is the target BP for those with CKD?
What drugs are used preferentially if you have to use drugs to tx BP? |
130/80 mmHg
ACE inhib, ARB. |
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What therapeutic agents should be avoided in those with CKD?
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Mag and phos containing cathartics
NSAID, COX-2 inhib Bisphosphonates Iodinated radiocontrast Gadolinium (can cause Nephrogenic systemic fibrosis if GFR < 30) |
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Are the kidneys in pts on dialysis smaller or larger than normal?
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smaller.
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What is Uremic syndrome? When does it occur re: GFR?
Clinical features? |
constellation of sx that begin when GFR falls to <60 mL/min
All sorts of stuff: - fatigue - peripheral neuropathy - anemia - GI bleeding - hiccups - HUGE list, etc. |
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Txplt is indicated when GFR falls below what?
When is dialysis indicated? |
<20
<10-15 |
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What is peritoneal dialsyis?
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Solution injected into the peritoneum, left there to get the solutes out, then draw it back out.
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Adaptive changes in nephron function maintain homeostasis and sustain life with physiologic and clinical consequences until the GFR falls to < ___ mL/min.
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10
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