11. Chronic Kidney Disease23 Flashcards
(117 cards)
1
Q
At what stage of Chronic Kidney Disease (CKD) is it recommended to consult a nephrologist?
A
Consultation with a nephrologist is recommended when stage 4 CKD develops (eGFR <30 mL/min/1.73 m2).
2
Q
What are the potential benefits of consulting a nephrologist when stage 4 CKD develops?
A
Consulting a nephrologist when stage 4 CKD develops has been found to reduce cost, improve quality of care, and delay dialysis.
3
Q
When should health care professionals consider referral to a nephrologist?
A
Health care professionals should consider referral to a nephrologist if the patient has continuously rising UACR levels and/or continuously declining eGFR, if there is uncertainty about the etiology of kidney disease, for difficult management issues (anemia, secondary hyperparathyroidism, significant increases in albuminuria in spite of good blood pressure management, metabolic bone disease, resistant hypertension, or electrolyte disturbances), or when there is advanced kidney disease (eGFR <30).
4
Q
What are some reasons to refer a patient to a nephrologist?
A
Some reasons to refer a patient to a nephrologist include continuously rising UACR levels, continuously declining eGFR, uncertainty about the etiology of kidney disease, difficult management issues (anemia, secondary hyperparathyroidism, significant increases in albuminuria despite good blood pressure management, metabolic bone disease, resistant hypertension, or electrolyte disturbances), or advanced kidney disease (eGFR <30).
5
Q
When should a patient be referred to a nephrologist for difficult management issues?
A
A patient should be referred to a nephrologist for difficult management issues such as anemia, secondary hyperparathyroidism, significant increases in albuminuria despite good blood pressure management, metabolic bone disease, resistant hypertension, or electrolyte disturbances.
6
Q
What percentage of study group participants discontinued due to hyperkalemia? IN (FIDELIO-DKD) trial FOR FINERENONE?
A
2.3%
NO HYPERKALEMIA DEATHS
7
Q
Were there any deaths related to hyperkalemia in the completed study?
A
No, there were no deaths related to hyperkalemia in the completed study.
8
Q
For what purpose can GLP-1 RAs be used at low eGFR?
A
GLP-1 RAs can be used at low eGFR for cardiovascular protection.
9
Q
What factors may influence the selection of specific agents for individuals with type 2 diabetes and CKD?
A
The selection of specific agents for individuals with type 2 diabetes and CKD may depend on comorbidity and CKD stage….
in individuals with eGFR ≥20 mL/min/1.73 m2 and UACR ≥200 mg/g
10
Q
Which trials provide evidence of the reduced cardiovascular and renal events with SGLT2 inhibitor use?
A
The CREDENCE and DAPA-CKD trials, as well as secondary analyses of cardiovascular outcomes trials with SGLT2 inhibitors, provide evidence of reduced cardiovascular and renal events.
IN PT WITH EGFR < 20
11
Q
What is the risk reduction of new or worsening nephropathy with semaglutide?
A
Semaglutide reduced the risk of new or worsening nephropathy by 36%.
12
Q
What does the composite of persistent UACR >300 mg/g creatinine, doubling of serum creatinine, or ESRD represent in the study?
A
The composite represents new or worsening nephropathy.
13
Q
By what percentage did liraglutide reduce the risk of new or worsening nephropathy?
A
Liraglutide reduced the risk of new or worsening nephropathy by 22%.
14
Q
By what percentage did canagliflozin reduce the risk of progression of albuminuria?
A
27%
15
Q
By what percentage did canagliflozin reduce the risk of reduction in eGFR, ESRD, or death from ESRD?
A
40%
16
Q
By what percentage did empagliflozin reduce the risk of incident or worsening nephropathy?
A
Empagliflozin reduced the risk of incident or worsening nephropathy by 39%.
17
Q
By what percentage did empagliflozin reduce the risk of doubling of serum creatinine accompanied by eGFR ≤45 mL/min/1.73 m2?
A
Empagliflozin reduced the risk of doubling of serum creatinine accompanied by eGFR ≤45 mL/min/1.73 m2 by 44%.
18
Q
WHEN are GLP-1 RAs suggested for CKD T2DM PT ?
A
GLP-1 RAs are suggested for cardiovascular risk reduction if such risk is a predominant problem.
19
Q
Who are SGLT2 inhibitors recommended for?
A
SGLT2 inhibitors are recommended for people with stage 3 CKD or higher and type 2 diabetes.
20
Q
What are the benefits of SGLT2 inhibitors for people with type 2 diabetes and CKD?
A
SGLT2 inhibitors slow CKD progression and reduce heart failure risk independent of glucose management.
21
Q
When should metformin be temporarily discontinued?
A
Metformin should be temporarily discontinued at the time of or before iodinated contrast imaging procedures in patients with eGFR 30–60 mL/min/1.73 m2.
22
Q
According to the article, should metformin be initiated for patients with an eGFR below what value?
A
Metformin should not be initiated for patients with an eGFR <45.
23
Q
At what eGFR level is metformin contraindicated?
A
Metformin is contraindicated in patients with an eGFR <30 mL/min/1.73 m2.
24
Q
What should be monitored while taking metformin?
A
eGFR should be monitored while taking metformin.
ESPECIALLY IF EGFR < 45
25
What is the reported effect of GLP-1 RAs on the kidney?
GLP-1 RAs have been reported to improve renal outcomes.
26
By how much do SGLT2 inhibitors reduce oxidative stress in the kidney?
SGLT2 inhibitors reduce oxidative stress in the kidney by >50%.
27
What are some effects of SGLT2 inhibitors on renal function?
SGLT2 inhibitors reduce renal tubular glucose reabsorption, weight, systemic blood pressure, intraglomerular pressure, and albuminuria and slow GFR loss.
28
What are the mechanisms by which SGLT2 inhibitors slow GFR loss?
The mechanisms by which SGLT2 inhibitors slow GFR loss appear to be independent of glycemia.
29
IF THERE IS NO CKD,...Are ACE inhibitors or ARBs superior to other classes of antihypertensive therapy?
No, ACE inhibitors or ARBs have not proven to be superior to alternative classes of antihypertensive therapy like thiazide-like diuretics and dihydropyridine calcium channel blockers.
30
According to the ACEI AND ARBS are considered to have similar benefits AND RISKS?
ACE inhibitors and ARBs are considered to have similar benefits AND RISKS.
31
In which cases may lower blood pressure targets be suitable?
Lower blood pressure targets may be suitable in some cases, especially in individuals with severely elevated albuminuria (≥300 mg/g creatinine).
32
What blood pressure level is recommended to reduce CVD mortality and slow CKD progression among all people with diabetes?
A blood pressure level <130/80 mmHg is recommended.
33
What is the recommended therapy for people with type 1 or 2 diabetes with established Chronic Kidney Disease (CKD) and high urine albumin levels?
ACE inhibitor or ARB therapy is recommended for people with type 1 or 2 diabetes with established CKD (eGFR <60 mL/min/1.73 m2 and UACR ≥300 mg/g creatinine) to reduce the risk of progression to ESRD.
34
How can restricting dietary sodium help in controlling blood pressure and reducing cardiovascular risk?
Restricting dietary sodium to less than 2,300 mg/day can help control blood pressure and reduce cardiovascular risk.
35
Why might the individualization of dietary potassium be necessary?
The individualization of dietary potassium may be necessary to control serum potassium concentrations.
36
What is the recommended daily allowance of dietary protein for individuals with chronic kidney disease?
The recommended daily allowance of dietary protein for individuals with chronic kidney disease is 0.8 g/kg/day.
37
Does reducing dietary protein below .8 G/KG/DAY the recommended daily allowance affect blood glucose levels, cardiovascular risk measures, or the course of GFR decline?
No, reducing dietary protein below the recommended daily allowance does not alter blood glucose levels, cardiovascular risk measures, or the course of GFR decline.
38
What are the potential negative effects associated with higher levels of dietary protein intake?
Higher levels of dietary protein intake have been associated with increased albuminuria, more rapid kidney function loss, and CVD mortality.
39
What are the risks associated with consuming more than 20% of daily calories from protein or more than 1.3 g/kg/day?
Consuming higher levels of dietary protein intake (>20% of daily calories from protein or >1.3 g/kg/day) has been associated with increased albuminuria, more rapid kidney function loss, and CVD mortality.
40
What are the only proven primary prevention interventions for CKD?
Blood glucose and blood pressure control.
41
When is screening for complications of CKD indicated?
Screening for complications of CKD is indicated when eGFR is <60 mL/min/1.73 m2.
BP, OVERLOAD, ANEMIA , BONE METABOLISM AND ELECTROLYTE.
42
In which type of diabetes may remission of albuminuria occur spontaneously?
Type 1 diabetes.
43
What is considered a valid surrogate for renal benefit IN CKD MANAGMENT?
An initial reduction of CREATININE >30% from baseline OR UACR <300 mg/g , subsequently maintained over at least 2 years, is considered a valid surrogate for renal AND CARDIAC benefit.
44
What may be detected by Early changes in kidney function ?
Increases in albuminuria before changes in eGFR.
45
What are the key components measured in the assessment of metabolic bone disease in CKD PT?
The key components measured in the assessment of metabolic bone disease are serum calcium, phosphate, PTH, and vitamin 25(OH)D.
46
What test is recommended to determine anemia?
Hemoglobin; iron testing if indicated.
47
What does serum electrolytes refer to?
Serum electrolytes refer to the levels of electrically charged particles, such as sodium, potassium, and chloride, in the blood plasma.
48
What methods can be used to assess volume overload?
Volume overload can be assessed through history, physical examination, and weight measurements.
49
What is the recommended blood pressure threshold for individuals with chronic kidney disease?
The recommended blood pressure threshold is >130/80 mmHg for individuals with chronic kidney disease.
50
What should be periodically measured in patients with eGFR <60 mL/min/1.73 m2 receiving ACE inhibitors, ARBs, or MRAs?
Serum potassium
51
Why should serum potassium be monitored in patients treated with diuretics?
Serum potassium should be monitored in patients treated with diuretics because these medications can cause hypokalemia, which is associated with cardiovascular risk and mortality.
52
What is the potential risk associated with hypokalemia caused by diuretics?
Hypokalemia caused by diuretics is associated with cardiovascular risk and mortality.
53
How often should both albuminuria and eGFR be monitored for timely diagnosis of CKD?
Both albuminuria and eGFR should be monitored annually.
54
Why are ACE inhibitors and ARBs commonly not dosed at maximum tolerated doses?
They are commonly not dosed at maximum tolerated doses because of fear that serum creatinine will rise.
وهذا خطا يمكن استخدامه بالجرعات القصوى بدون خوف حتي مع Ckd
55
When should ACE inhibitors and ARBs not be discontinued?
ACE inhibitors and ARBs should not be discontinued for increases in serum creatinine (<30%) in the absence of volume depletion.
56
What should not be confused with AKI when using RAS blockers?
Elevations in serum creatinine (up to 30% from baseline)
57
How can SGLT2 inhibitors promote AKI?
SGLT2 inhibitors may promote AKI through volume depletion, particularly when combined with diuretics.
بس الناس اللي وظايف الكلي كويسه ما عليهم خطر
58
Which antihypertensive medications can CAUSE AKI & reduce intravascular volume, renal blood flow, and/or glomerular filtration?
Diuretics, ACE inhibitors, and angiotensin receptor blockers (ARBs)
59
What are some effects of antihypertensive medications on the kidneys?
Reduction in intravascular volume, renal blood flow, and/or glomerular filtration
60
Are people with diabetes at a higher risk of Acute Kidney Injury (AKI) compared to those without diabetes?
Yes, people with diabetes are at higher risk of AKI than those without diabetes.
61
How is acute kidney injury (AKI) diagnosed?
Acute kidney injury (AKI) is diagnosed by a 50% or greater sustained increase in serum creatinine over a short period of time, which is also reflected as a rapid decrease in eGFR.
62
What are the diagnostic criteria for acute kidney injury (AKI)?
The diagnostic criteria for acute kidney injury (AKI) include a 50% or greater sustained increase in serum creatinine over a short period of time, which is also reflected as a rapid decrease in eGFR.
63
What does KDIGO recommend in CKD staging?
KDIGO recommends a more comprehensive CKD staging that incorporates albuminuria at all stages of eGFR.
64
What is the association between the degree of albuminuria and risk of cardiovascular disease (CVD)?
The degree of albuminuria is associated with the risk of cardiovascular disease (CVD) at any eGFR.
65
How are stage 1 and stage 2 chronic kidney disease (CKD) defined?
Stage 1 and stage 2 CKD are defined by evidence of high albuminuria with eGFR greater than or equal to 60.
66
Is it common for people with type 1 diabetes to develop kidney disease without retinopathy?
No, it is rare for people with type 1 diabetes to develop kidney disease without retinopathy.
67
Is it common for people with type 1 diabetes to develop kidney disease without retinopathy?
No, it is rare for people with type 1 diabetes to develop kidney disease without retinopathy.
68
What are some indicators that suggest alternative or additional causes of kidney disease? WHEN TO REFER TO NEPHROLOGIST?
An active urinary sediment (containing red or white blood cells or cellular casts), rapidly increasing albuminuria or total proteinuria, the presence of nephrotic syndrome, rapidly decreasing eGFR, or the absence of retinopathy (in type 1 diabetes)
69
What does the presence of an active urinary sediment suggest regarding kidney disease?
The presence of an active urinary sediment suggests alternative or additional causes of kidney disease.
70
REGARDING CKD What is frequently reported in type 1 and type 2 diabetes?
Reduced eGFR without albuminuria.
71
What are the typical presentation features of diabetic kidney disease?
The typical presentation of diabetic kidney disease includes a long-standing duration of diabetes, retinopathy, albuminuria without gross hematuria, and gradually progressive loss of eGFR....
IN T2DM MAYBE THERE IS CKD WITH NO RETINOPATHY AT DIAGNISIS TIME.
72
How is diabetic kidney disease typically diagnosed?
Diabetic kidney disease is usually diagnosed based on the presence of albuminuria and/or reduced eGFR in the absence of signs or symptoms of other primary causes of kidney damage.
73
TO CALCIULATE EGFR Why is combining filtration markers more accurate than using either marker alone?
Combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than using either marker alone.
74
What is considered an abnormal eGFR value?
An eGFR persistently <60 mL/min/1.73 m2 in concert with a urinary albumin value of >30 mg/g creatinine is considered abnormal.
75
What are some factors that can independently elevate UACR?
Exercise within 24 h, infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension can independently elevate UACR.
76
What does UACR stand for?
UACR stands for Urine Albumin-to-Creatinine Ratio.
77
How many specimens of UACR should be collected within a 3- to 6-month period before considering a patient to have moderately or severely elevated albuminuria?
Two of three specimens should be abnormal.
BECAUSE HIGH VARIABILITY OF ACR.
78
What is the high biological variability between measurements in urinary albumin excretion?
>20%
79
How is normal albuminuria defined?
Normal albuminuria is defined as <30 mg/g creatinine.
80
What is the definition of moderately elevated albuminuria?
Moderately elevated albuminuria is defined as ≥30–300 mg/g creatinine.
81
What is the expected positivity rate in dipstick screening tests for those with moderately increased albuminuria?
The expected positivity rate in dipstick screening tests for those with moderately increased albuminuria (≥30 mg/g) should be >85% positive.
82
What is the potential DISADANTAGES of measuring albumin alone in a spot urine sample without measuring urine creatinine simultaneously?
The potential drawback is the susceptibility to false-negative and false-positive determinations due to variation in urine concentration as a result of hydration.
83
What is the recommended method for screening albuminuria?
The recommended method for screening albuminuria is urinary albumin-to-creatinine ratio (UACR) in a random spot urine collection.
84
When does diabetic kidney disease typically develop in type 1 diabetes? AND T2DM?
Diabetic kidney disease typically develops after a diabetes duration of 10 years (5-15) in type 1 diabetes.
AT DIAGNOSIS T2DM.
85
What percentage of people with diabetes experience CKD attributed to diabetes in adults?
20-40%
86
How is chronic kidney disease (CKD) diagnosed?
Chronic kidney disease (CKD) is diagnosed by the persistent elevation of urinary albumin excretion (albuminuria), low estimated glomerular filtration rate (eGFR), or other manifestations of kidney damage.
87
What are the indicators used for diagnosing chronic kidney disease (CKD)?
The indicators used for diagnosing chronic kidney disease (CKD) are persistent elevation of urinary albumin excretion (albuminuria), low estimated glomerular filtration rate (eGFR), or other manifestations of kidney damage.
88
When should a patient be referred to a nephrologist?
A patient should be referred to a nephrologist for uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease.
89
What are some reasons to promptly refer a patient to a nephrologist?
Some reasons to promptly refer a patient to a nephrologist include uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease.
90
When should patients be referred for evaluation by a nephrologist?
Patients should be referred for evaluation by a nephrologist if they have continuously increasing urinary albumin levels and/or continuously decreasing estimated glomerular filtration rate and if the estimated glomerular filtration rate is <30 mL/min/1.73 m2.
91
What are the criteria for referring patients for evaluation by a nephrologist?
Patients should be referred for evaluation by a nephrologist if they have continuously increasing urinary albumin levels and/or continuously decreasing estimated glomerular filtration rate and if the estimated glomerular filtration rate is <30 mL/min/1.73 m2.
92
What is the recommended dietary protein intake for people with non-dialysis-dependent stage 3 or higher chronic kidney disease?
The recommended dietary protein intake for people with non-dialysis-dependent stage 3 or higher chronic kidney disease is 0.8 g/kg body weight per day.
93
Why should higher levels of dietary protein intake be considered for patients on dialysis?
Higher levels of dietary protein intake should be considered for patients on dialysis because protein energy wasting is a major problem in some individuals on dialysis.
94
What is the target level of dietary protein intake for patients on dialysis?
There is no specific target level mentioned for dietary protein intake for patients on dialysis in the provided content.
95
What is the recommended reduction in mg/g urinary albumin for people with chronic kidney disease who have ≥300 mg/g urinary albumin?
A reduction of 30% or greater in mg/g urinary albumin is recommended.
96
Who should aim for a reduction of 30% or greater in mg/g urinary albumin?
People with chronic kidney disease who have ≥300 mg/g urinary albumin.
97
What is recommended to reduce chronic kidney disease progression and cardiovascular events in people with chronic kidney disease and albuminuria?
A nonsteroidal mineralocorticoid receptor antagonist shown to be effective in clinical trials.
98
Who are recommended to take a nonsteroidal mineralocorticoid receptor antagonist?
People with chronic kidney disease and albuminuria who are at increased risk for cardiovascular events or chronic kidney disease progression.
99
What are the three additional medications recommended for cardiovascular risk reduction in people with type 2 diabetes and diabetic kidney disease?
The three additional medications recommended for cardiovascular risk reduction in people with type 2 diabetes and diabetic kidney disease are sodium–glucose cotransporter 2 inhibitors (if estimated glomerular filtration rate is ≥20 mL/min/1.73 m2), a glucagon-like peptide 1 agonist, or a nonsteroidal mineralocorticoid receptor antagonist (if estimated glomerular filtration rate is ≥25 mL/min/1.73 m2).
100
What is the recommended estimated glomerular filtration rate (eGFR) threshold for the use of sodium–glucose cotransporter 2 inhibitors in people with type 2 diabetes and diabetic kidney disease?
The recommended eGFR threshold for the use of sodium–glucose cotransporter 2 inhibitors in people with type 2 diabetes and diabetic kidney disease is ≥20 mL/min/1.73 m2.
101
What is the recommended estimated glomerular filtration rate (eGFR) threshold for the use of a nonsteroidal mineralocorticoid receptor antagonist in people with type 2 diabetes and diabetic kidney disease?
The recommended eGFR threshold for the use of a nonsteroidal mineralocorticoid receptor antagonist in people with type 2 diabetes and diabetic kidney disease is ≥25 mL/min/1.73 m2.
102
Why is the use of a sodium-glucose cotransporter 2 inhibitor recommended for people with type 2 diabetes and diabetic kidney disease?
The use of a sodium-glucose cotransporter 2 inhibitor is recommended to reduce chronic kidney disease progression and cardiovascular events.
103
What are the criteria for recommending sodium-glucose cotransporter 2 inhibitor use in patients with type 2 diabetes and diabetic kidney disease?
The criteria for recommending sodium-glucose cotransporter 2 inhibitor use are an estimated glomerular filtration rate ≥20 mL/min/1.73 m2 and urinary albumin ranging from normal to 200 mg/g creatinine.
104
What type of patients is the use of a sodium-glucose cotransporter 2 inhibitor recommended for?
The use of a sodium-glucose cotransporter 2 inhibitor is recommended for patients with type 2 diabetes, diabetic kidney disease, an estimated glomerular filtration rate ≥20 mL/min/1.73 m2, and urinary albumin ≥200 mg/g creatinine.
105
What is the purpose of using a sodium-glucose cotransporter 2 inhibitor in patients with type 2 diabetes and diabetic kidney disease?
The purpose of using a sodium-glucose cotransporter 2 inhibitor is to reduce chronic kidney disease progression and cardiovascular events in these patients.
106
When should renin-angiotensin system blockade not be discontinued?
Renin-angiotensin system blockade should not be discontinued for increases in serum creatinine (≤30%) in the absence of volume depletion.
107
According to the article, is an ACE inhibitor or an angiotensin receptor blocker recommended for the primary prevention of chronic kidney disease in people with diabetes who have normal blood pressure, normal urinary albumin-to-creatinine ratio, and normal estimated glomerular filtration rate?
No, an ACE inhibitor or an angiotensin receptor blocker is not recommended for the primary prevention of chronic kidney disease in people with diabetes who have normal blood pressure, normal urinary albumin-to-creatinine ratio (<30 mg/g creatinine), and normal estimated glomerular filtration rate.
108
What are the criteria for not recommending an ACE inhibitor or an angiotensin receptor blocker for the primary prevention of chronic kidney disease in people with diabetes?
The criteria for not recommending an ACE inhibitor or an angiotensin receptor blocker for the primary prevention of chronic kidney disease in people with diabetes are normal blood pressure, normal urinary albumin-to-creatinine ratio (<30 mg/g creatinine), and normal estimated glomerular filtration rate.
109
What should be periodically monitored when using ACE inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists?
Serum creatinine and potassium levels should be periodically monitored.
110
What are the potential development risks when using ACE inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists?
The potential development risks include increased creatinine and hyperkalemia.
111
What is the recommended treatment for nonpregnant people with diabetes and hypertension with moderately increased albuminuria?
Either an ACE inhibitor or an angiotensin receptor blocker.
112
What is the definition of moderately increased albuminuria in nonpregnant people with diabetes and hypertension?
Moderately increased albuminuria is defined as a urinary albumin-to-creatinine ratio of 30–299 mg/g creatinine.
113
What is the recommended treatment to reduce the risk or slow the progression of chronic kidney disease?
Optimize glucose control and optimize blood pressure control and reduce blood pressure variability.
114
What are the two specific recommendations for reducing the risk or slowing the progression of chronic kidney disease?
Optimizing glucose control and optimizing blood pressure control and reducing blood pressure variability.
115
How often should urinary albumin and estimated glomerular filtration rate be assessed in people with type 1 diabetes?
At least annually.
116
How often should urinary albumin and estimated glomerular filtration rate be monitored in people with established diabetic kidney disease?
1-4 times per year depending on the stage of the disease.
117
Who should undergo assessments for urinary albumin and estimated glomerular filtration rate?
People with type 1 diabetes with duration of ≥5 years and all people with type 2 diabetes regardless of treatment.
