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GU1 - Nephrology > Clin Med - CKD > Flashcards

Clin Med - CKD Flashcards

1
Q

What labs should you get before CKD appt?

A
  • CBC
  • RFP (or CMP/BMP)
  • Intact PTH
  • UA
  • Random urine for protein and creatinine (need ratio)
  • Renal US

*Old labs are VERY important

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2
Q

Causes of CKD (many)

A

-Diabetes and HTN are 2 MCC!

  • Polycystic kidney disease
  • Heart Disease (CHF)
  • Sarcoid
  • NSAIDs/other nephrotoxins
  • Vasculitis (including SLE, anti-GBM, ANCA)
  • Connective tissue diseases (including CREST, SLE, RA, scleroderma)
  • Renal Artery stenosis
  • Benign hematuria
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3
Q

CKD can cause…

A
  • Anemia
  • Mineral and Bone Disorders (MBD)
  • Impaired immunity
  • Volume Overload
  • Hyperkalemia
  • Metabolic Acidosis
  • Hypertension
  • Dyslipidemia
  • Sexual Dysfunction
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4
Q

Anemia seen with CKD is d/t

A
  • reduced production of erythropoietin and shortened red cell survival.
  • Normocytic, normochromic - anemia of chronic disease
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5
Q

What do you have to do before treating anemia in CKD?

A

Rule out all other non-renal causes. Often won’t treat until Hgb is below 10

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6
Q

What GFR is anemia common in?

A

GFR below 60 mL/min

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7
Q

Mineral and bone disorders seen with CKD

A
  • Secondary hyperparathyroidism
  • Hyperphosphatemia
  • Hypocalcemia
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8
Q

Volume overload and sodium relationship

A

Less able to respond to rapid intake of sodium, therefore prone to fluid overload

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9
Q

Where is the fluid seen in volume overload?

A

Often in lower extremities, occasionally in abdomen, lungs

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10
Q

Tx of volume overload

A

Usually respond well to dietary sodium restriction and diuretic therapy with loop diuretic daily

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11
Q

What is the KDIGO sodium intake recommendation?

A

KDIGO (Kidney Disease: Improving Global Outcomes) recommends sodium intake be restricted to <2 g/day

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12
Q

Cause of hyperkalemia in CKD

A

Numerous, but often have high potassium diets

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13
Q

Tx of hyperkalemia

A

Start with low-potassium diet (1500-2700 mg/day)

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14
Q

Meds for hyperkalemia

A

kayexalate and fludrocortisone

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15
Q

Why do CKD patients get metabolic acidosis?

A

CKD patients tend to retain hydrogen ions leading to progressive metabolic acidosis

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16
Q

When is serum bicarb stabilized?

A

Between 12 and 20 mEq/L, rarely < 10

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17
Q

Tx for metabolic acidosis

A

May treat with sodium bicarbonate unless significant edema/CHF

*monitor volume status carefully

18
Q

Other complications of CKD

A
  • Impaired Immunity
  • Dyslipidemia
  • Sexual dysfunction
19
Q

Management of CKD - meds

A

ACEi and ARB

20
Q

Common nephrotoxins

A

NSAIDs and PPIs

21
Q

Diet/lifestyle recommendation for CKD

A

Heart healthy, ~4oz protein/meal, low sodium

Stop smoking!!

22
Q

What can you recommend to replace NSAIDs for arthritis in CKD?

A

Tylenol arthritis strength

23
Q

Renal ultrasound is used to

A

used to rule out obstruction, masses, polycystic kidney disease

24
Q

Large kidneys on renal US, think…

A

infiltrating diseases (Amyloid, DM, PCKD)

25
Q

Small kidneys on renal US, think…

A

indicate long term CKD, frequently found with HTN

26
Q

What is normal kidney size?

A

11-15cm

27
Q

Biggest indication for kidney biopsy

A

Proteinuria in the absence of diabetes

28
Q

Do all patients get a biopsy?

A

No, biopsy is the exception, not the rule. Renal US are the norm, every patient gets them.

29
Q

Indications for further blood work

A
  • Proteinuria in absence of diabetes
  • Pre-biopsy
  • Unexplained hematuria

*blood work ordered before every appointment

30
Q

CKD Stage 1

A

Stage 1—GFR 90-120

31
Q

CKD Stage 2

A

GFR 60-90

32
Q

CKD Stage 3

A

GFR 30-60

33
Q

CKD Stage 4

A

GFR 15-30

34
Q

CKD Stage 5

A

CFR < 15

35
Q

ESRD — GFR

A

< 15 with uremic symptoms

36
Q

Pearls - when to send to nephrologist

A
  • Hematuria after urology evaluation
  • Proteinuria
  • Progressive insufficiency
  • Acute worsening
  • CKD 3 (early stage 3, make patient aware of disease; definitely refer < 45)
37
Q

Pearls - urine studies

A

(don’t order 24 hr)

Estimated protein excretion ratio is recommended test for eval of proteinuria

38
Q

Example of CKD Plan

A
  • Control DM, HTN
  • Return to clinic in 3 months with labs: CBC, RFP, iPTH, UA, random urine for protein/creatinine
  • Low salt diet
  • Diuretic
39
Q

Cockcroft-Gault Equation

A

CrCl (mL/min) = [140(age) x ideal bodyweight (kg)] / [0.815* x serum creatinine]

*use 0.85 for females

40
Q

Select the target goal for protein restriction in patients with normal serum albumin and CKD

A

4oz protein/meal

GU1 - Nephrology (16 decks)

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