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26 Cards in this Set
- Front
- Back
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KDIGO, the CGA classification stands for what?
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cause, GFR, albuminuria
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lifetime Chance of getting ESRD
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30%
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2 most common etiologies of ESRD
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diabetes, HTN
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Genetic connection for AA pts with ESRD
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Apolipoprotein L1
-variants can lyse trypanosoma 10-12% carry two APOL1 risk alleles |
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Path of HTN in CKD
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ECF expansion
dec in NO (vasoconstriction) dec vascular compliance renal vascular dz and RAS |
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Tx with HTN for CKD pts
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target BP of 130/80
inhibit RAAS |
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After RAS inhibitors, what meds should be used?
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diuretics
CCB mineralocorticoid blockade |
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1st step in pt with proteinuria
Additional Tx? |
control HTN
RAS blockade (watch for hyperkalemia when GFR <20) dietary Na restriction diuretics |
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Describe ammoniagenesis in CKD.
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total ammoniagenesis is dec, but individual nephrons will inc.
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Tx for low serum bicarb in CKD
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give supplement bicarb up to about 23.
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Side effects with Ca cycle in CKD
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osteitis fibrosa cystica
vascular calcification inc PTH synthesis |
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Where can osteitis fibrosa cystica present?
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Rugger jersey spine
reabsorption in phalanges |
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If calcific uremic arteriolopathy occurs, what is the pt outlook?
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poor, high mortality at 6mo
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How can Ca complications in CKD can controlled?
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keep Ca and serum phosphorus at normal levels
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What does cinacalcet do?
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blocks the stimulation of PTH secretion by dec Ca
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What cannot be done to treat high phosphorus levels?
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restrict protein diets
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Clinical features of uremia
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N/anorexia
dec cognitive function impaired sleep peripheral neuropathy seizures coma serositis (like pericarditis) systemic inflammation anemia bleeding poor growth bone dz infertility |
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When is renal tx considered?
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GFR <20
dialysis <10-15 |
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Describe the flow of dialysate and blood.
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counter-current, allows urea and creatinine to flow into diasylate
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Which catheter is the lowest on the totem pole?
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tunneled Central venous catheters
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peritoneal v. hemodialysis time constraints
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peritoneal is each night for 9 hrs
hemodialysis is 3x/week for a few hrs |
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Education for CKD pts
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save veins for fistula creation
complete eval for waitlist by eGFR 20 identify kidney donors and perform preemptive transplant |
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What do most CKD pts die of?
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CVD (<45 GFR)
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Origin of anemia in CKD
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low EPO production
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What should be corrected first in CKD pts with anemia?
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iron deficiency
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Agents to avoid in CKD
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Mg and P
NSAIDs, COX-2 inhibitors bisphosphonates iodinated radiocontrast gadolinium (GFR <30) |
