OnlineMedEd: Nephrology - "Chronic Kidney Disease"

Question 1

Go through the stages of CKD and list GFR and management.

Answer 1

• I: greater than 90; prevent progression (true of every stage)
• II: 60 - 89; “ “
• III: 30 - 59; “ “
• IV: 16 - 29; “ “; prepare HD
• V: less than 15; “ “; HD

Question 2

What does “prevent progression” mean?

Answer 2

• Manage HTN
• Treat DM
• Check for proteinuria

Question 3

What factors are unique in the treatment of DM in those with CKD?

Answer 3

• Metformin cannot be given to someone with CKD.

* Insulin is renally cleared, so any kind of insulin needs to be carefully dosed to avoid hypoglycemia.

Question 4

How is anemia of CKD diagnosed?

Answer 4

There is no test for it –it is a diagnosis of exclusion.

Question 5

Anemia of CKD should be treated with _______________.

Answer 5

Fe, EPO, and transfusion for Hgb less than 10

Question 6

Explain the pathophysiology of secondary hyperparathyroidism of CKD.

Answer 6

The damaged kidney does not make vitamin D, so calcium is low. The damaged kidney also does not clear phosphate, so phosphate rises. Both of these factors stimulate the release of PTH.

Question 7

Why does phosphate continue to rise in kidney disease?

Answer 7

PTH stimulates the release of more phosphate from the bones, but the kidneys cannot clear it.

Question 8

How is hyperphosphatemia treated?

Answer 8

• Sevelamer binds phosphate in the gut and clears it (think of the dump trunk ShoVELER in the Sketchy scene).
• Cinacalcet stimulates the calcium receptors on the parathyroid and reduces the secretion of PTH.
• Replace vitamin D (to correct calcium).