Health Disparities - Renal Flashcards
What are some occupational / environmental exposures that can contribute to morbidity and mortality associated with CKD?
Heavy metals –> chronic tubulointerstitial nephropathy
Silica –> chronic glomerulonephropathy
Radiation, CS2 –> Vascular nephropathy
What are some preventative measures that we can take as clinicians to help patients reduce risk of CKD?
Kidney disease is the […] leading cause of mortality in the U.S.
9th
If a clinician were to diagnose someone with CKD based solely on increases in albuminuria, what are the stages that the decline could be graded as?
What protein is used as the marker in kidney damage?
Why?
Albumin is the marker of kidney damage
It’s the most abundant protein in the blood plasma and normally there should be very little in the urine
Approximately how many people die per year in the U.S. from kidney disease?
13 per 100,000
What are some institutional factors that influence patient behaviors surrounding treatment for CKD?
Explain how to use this table.
The table takes into account a person’s GFR and albuminuria to provide clinicians with guidelines on how many times per year they should follow up with the patient as it pertains to their kidney function. The number in the boxes is the times per year they should see their doctor for kidney followup, and the color indicates the level of risk (green = low, yellow = slight, orange = moderate, red = high, dark red = very high)
What are some risk factors for developing CKD?
DM and HTN are huge
Prevalence is higher in women, but disease progression and mortality is worse in men, ESRD also higher in men
Some stats
- Approximately […] adults have CKD in the U.S.
- […] % have stages 1 - 3
- […]% at stages 1-3 are not aware they have CKD
- […]% at stage 4 are not aware they have CKD
- 30 million
- 95
- 96
- 48
Given that many people who have CKD are asymptomatic and it goes undiagnosed until it reaches later stages:
- Should we be doing population based screening?
- Should we be doing subgroup level screening in those who have risk factors (i.e. HTN and DM)?
- Guidelines are unclear, but seems to suggest that there’s no benefit to doing population level screening
- It is however helpful to do screening in DM and HTN patients
DM and HTN are the primary causes for […] of 10 new cases of CKD
7
What are some reasons why a person who is a minority might experience decreased quality of health care / health outcomes when being treated for CKD compared to a non-minority person?
If a clinician were to diagnose someone with CKD based solely on declines in GFR:
- How many stages of decline are there?
- What is the impact of age?
- What are the categories based on?
Why is the overall prevalence of CKD increasing?
What populations have seen dramatic increases in CKD over the lsat 15 years?
What populations have seen a decrease?
Treatment has improved, people are living longer with the disease
Native hawaiian/pacific islanders
American Indians/Alaskan Natives
How is CKD clinically defined?
What are some flaws at the level of the healthcare system itself that prevent people from getting appropriate care for CKD?
What is the general mechanism of injury in CKD?
Hyperfiltration triggers cascade of events –> hypertrophy of kidney –> increased filtration = increased fluid = increased capillary pressure –> capillary injury –> impairment of normal kidney function (regulate pH, regulate fluid balance, regulate ions in plasma, endocrine functions)
