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63 Cards in this Set
- Front
- Back
What is chronic kidney disease also referred to as?
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CKI- chronic kidney insufficiency
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How do you define this?
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kidney damage or kidney function decreased (decreased GFR) for 3 mo or more
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What can CKD lead to?
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ESRD
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Define ESRD?
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when kidney function is insufficient to sustain life
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What is needed?
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hemodialysis, peritoneal dialysis, or kidney transplant is substituted
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What are some of the suseptibility factors of CKD?
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age, decreased kidney mass, low birth weight, systemic inflammation, dyslipidemia, family history of CKD, racial/ehtnic minority, low income or eduction
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What are some initation factors?
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diabetes, hypertension, autoimmune disease, polyscystic kidney disease, drug toxicity
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What are some of the progression factors?
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poor glucose, blood pressure, proteinuria, smoking
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What plays a major role in progression of CKD?
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angiotensin II
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What happens to nephrons?
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to meet excretory demands, remaining nephrons undergo adaptations that increase single nephron GFR
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What is the most prominent change?
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glomerular hemodynamic adaptations (glomerular capillary htn)
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What does this lead to?
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glomerular sclerosis, neophron death
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How is glomerular htn maintained?
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primarily by angiotensin mehcanisms (increase BP, vasoconstriction of efferent arterioles)
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what else does angiotensin have?
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non-hemodyanmic effects that are important in progression of CKD
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What symptoms do you see in stage 1-2?
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non-absent
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What happes in stage 3-4?
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symptomatic, electrolyte disturbances, symp anemia
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What are classic symptoms with stage 5?
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pruritis, dysgeusia, nausea, vomiting, bleeding abnormalities
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what are symptoms of anemia?
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cold intolerance, sob, fatigue
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What is the severity of the symtpoms related to?
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rate of anemia development and the degree of hemoglobin reduction
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Describe stage 1?
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kidney damage , normal GFR >90
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stage 2
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kidney damage, mild decrease GFR 60-89
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stage 3
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moderate decrease GFR 30-59
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stage 4
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sever decrease gFR 15-29
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stage 5
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kidney failure <15 (on dialysis)
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What can slow the progression of renal failure?
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acei, arb
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When does the protective effect have the greatest impact?
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if initiated early, 1,2 females, 1.5 males, GFR<60
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What happens if you wait till the disease progresses?
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the likelihood of success decreases
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Who should be treated with ace regarldess of htn?
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people with CKD and proteinuria
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Who were ace shown to be more effective in?
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type 1 diabetes
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Who were arbs shown to be more effective?
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type 2 diabetes
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what type of doses should be used?
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moderate to high
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What should be monitored?
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blood pressure, serum creatinine, serum K
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When?
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1-2 weeks after initiations of therapy with ace
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What is the target total protein to creatinine?
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<500-1000 mg/g
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Who should use combo?
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lower bp or reduce proteinuria--safe and results in a great decrease in protein
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What is a major risk for development and progression of CKD?
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hyptertension
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What else can it worsen?
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cardivovascular disease in CKD
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What are the goals in hypertensive therapy?
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lower BP, slow progession of kidney disease, and reduce CVD risk
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What should be used to tx the hypertension?
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ACEI, ARB
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What will most patients require?
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tx with more than 1 drug
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What should you use if you max out ace/arb?
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diuretic, CCB, beta blcoker
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when should you use a thiazide/loop?
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thiazide if GFR>30, loop GFR<30, K sparing used with CAUTION
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Which calcium channel blockers should be used?
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verapamil, diltiazem -nondihydropyridine
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what does glycemic control depend on?
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stage at which it is begun, and degree of normalization of glucose metabolism
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what did tight glycemic control do?
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reduced incidence of microalbuminuria and albuminuria
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What is contreversial?
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dietary protein restriction
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What is wrong with this?
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compliance is difficult
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what is the recommended for GFR <25?
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0.6g/kg/day
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What if they have problems with nutrition?
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0.75 g/kg/day
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What is the goal of hyperlipidemia tx?
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to reduce risk for progressive cardiovascular dsiease
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What is the secondary goal of tx?
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reduction in protein and renal fucntion decline
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What is the goal LDL?
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<100 mg/dl in patietns with CKD
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What has smoking cessation shown?
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smoking is associated with faster rate of progression
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What does smoking cessation result in?
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protective effect against protien and reduced GFR
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What is a risk factor of chronic renal dysfunction to ESRD?
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anemia
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What might worsen CKD progression?
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hypoxia
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What might be beneficial?
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decreasing hypoxia by correcting anemia may be beneficial
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What is the goal of protein?
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<.5g/day
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what is the goal of GFR?
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<2 ml/min/y
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What is the goal bp?
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<130/80
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What is the dietary protein resitriction?
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0.6 g/kg/day- 0.75
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What is the goal hga1c?
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6.50%
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What is the goal LDL?
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<100
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