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25 Cards in this Set

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What do prostolglandins do to the afferent/efferent arteriole?
vasodilate
What are 2 responses when your systemic hemodynamics are compromised?
Ang II/NE -->vasoconstrict

Prostaglandins --> vasodilate (blunts some of the vasoconstriction)
Why are NSAIDs with CHF bad?
NSAID leads to unopposed vasocnstriction-->fall in GFR

because in CHF:

Ang II/NE -->vasoconstrict

Prostaglandins --> vasodilate (blunts some of the vasoconstriction)

and NSAIDs stop this prostaglandin
CKD Definition
GFR < 60 for greater than 3 months

and/or

Structural or Functional Abnormalities of the Kidneys
the following tests are recommended on a yearly basis for pts with what 2 problems?

BMP for Creatinine/GFR
Urinalysis for protein, hematuria, casts
Urinalysis for Microalbuminuria
diabetes or hypertension.
clinical manifestations of CKD? 4
Cardiovascular Disease

Anemia

Bone Disease

Increased Infection Rate
a pt with CKD is more likely to die from what?
Patients with CKD are more likely to die of cardiovascular disease before they progress to end-stage renal disease (ESRD)
Mechanism of CKD and CV disease? 5 steps
abberant mineral metabolism (from minerals not getting out and PTH increase) -->

vascular calcification-->

loss of vessel compliance-->

HT and L ventricular hypertrophy-->

Diastolic Dysfunction/Decreased Coronary Perfusion
starting with hypoxemia, how do you get to endothelial dysfunction with CKD?
hypoxemia-->increased free radicals--> endothelial dysfunction
Anemia is normally seen in what stage CKD?
4/5
how do you have anemia with CKD?
Due to decreased erythropoietin production
what are signs and symptoms of anemia?
tachycardia, look pale, feels like heart is racing

fatigue

decreased exercise tolerance

syncope
pt says that they get tired with exercise, and they feel like their heart is racing. They appear pale and are tachycardic..what is going on?
Anema
when do you give erythropoietin?
when Hg is <10g/dL
What is your target Hg level when you are giving a pt eryhtropoietin?
remember they had less than 10 g/dL to be treated

target level is 11-12
Before starting erythropoietin-stimulating agents what 2 things should you check?
Rule out other causes of anemia such as B12 deficiency, GI bleed, hemolysis

Check for adequate iron stores
-Ferritin should be greater than 100
when you have CKD, what happens to phosphorus clearance?
it goes down

this will use up your free Ca
what happens to vit D in CKD?
Decreased conversion of vitamin D2 (inactive form) to vitamin D3 (active form)
What conditions usually stimulate
PTH release? 3
Low serum Ca

High Phosphorus level

low Vit D
“Brown” tumors → what are they? where are they seen? in what problem?
get erosive osteolytic lesions (look black on xray)

seen on fingers and clavical

side effect of bone breakdown seen in CKD!!!
What lab abnormalities would you expect to see as a result of secondary hyperparathyroidism? (assume no intervention) 4
still have high phosphorous (can't quite overcome it)

low to normal Ca (bone turnover can only do so much, you can't absorb it without Vit D)

high alkalate phosphatase (due to bone destruction)

low vit D
with CKD what can happen to your immune function? what is this due to?

tx?
Decreased B cell, T cell and macrophage function due to uremic toxins

TREATMENT = PREVENTION
Vaccinate
-Hepatitis B
-Influenza
-Strep Pneumo
new patient in the nephrology clinic. She was referred by her PCP because she was recently diagnosed with CKD (GFR 55.)

What tests did the PCP do to screen for CKD?
urinalysis

serum chemistry

urine microalbumin
What additional tests will you order to screen for systemic complications of CKD, and why?
Hg

Lipids

Ca, Phos, PTH level,
The CKD patient is found to have a blood pressure of 155/95. What is her target BP?

What are the preferred BP lowering agents in diabetics?
less than 130/80

ACE/ARB