Flashcards in Alex: Chronic Kidney Disease (Progression and Complications) Deck (64)
What is true of individual rates of decline in terms of GFR in CKD ?
Each person with CKD has their own individual rate of decline of GFR that is unique to them and stays the SAME throughout the course of their disease
At what GFR do you usually give dialysis or transplant ?
GFR < 15, ( she usually shows it under 10)
List the two non-modifiable risks for progression of CKD
Race and Gender
What are 3 Modifiable risk factors for the progression of CKD ?
Compensetory Hyperfiltration (Intraglomeruar HTN and Nephron Hypertrophy)
At what BP should you consider ACEi or diuretic to help prevent CKD complication in patients with Diabetes Mellitus Type II?
Trick question ! BP should have nothing to do with it. BP lowering meds can be given to any DM2 patient for prevention of CKD and its complications
What is the BP goal for patients with Stage I-IV CKD who also have Proteinuria or Diabetes ?
How about for Stage I-IV w/o proteinuria ?
125/75 or less
Compare this to BP goals for the ten pop ( 140/90)
what percentage of people with CKD have controlled HTN ?
Less than 40%
How many drugs is the average patient with CKD and HTN on to control BP ?
At least 2
Most therapies to control BP do so by altering what regulatory system ?
What molecule in the RAAS pathway is the most important target for reducing Intraglomerular pressure in Compensatory Hyperfiltration ?
Angiotensin II (It causes vasoconstriction of the efferent arteriole)
What adverse effects does AT II cause ?
Glomerular capillary hypertension
Abnormal glomerular permselectivity
Mesangial cell proliferation
Induction of TGF-b with increase in extracellular matrix
Stimulation of adrenal production of aldosterone
What do the adverse effects of AT II ultimately cause ?
List the 4 classes of drugs that will shift the RAAS axis
Administration of ACE or ARBs will lead to which effects within the glomerulus ?
Decreased efferent arteriole vasoconstriction
Decreased glomerular filtration pressure
By limiting RAAS activation of Intraglomerular HTN and Glomerular HTN, what process is being limited by the use of Anti-RAAS drugs ?
Glomerular scarring and fibrosis
ACE and ARBs have been shown to slow the progression of CKD in patients who are Diabetic , Non-Diabetic or both ?
ACEi and ARBs decrease glomerular fibrosis and scarring by decreasing of inhibiting which 4 processes ?
Release of TGF-b
Inhibition of pro-collagen formation.
Aggressive treatment with ACE/ARB's is needed at which BP's for patients with CKD ?
SBP< 130 & DBP< 80 mmHg with presence of 1-2 gm/d proteinuria
Even more aggressive BP goals with diabetic nephropathy or greater degrees of proteinuria
What is the goal for decreasing baseline proteinuria in patients with CKD ?
Try to decrease it by 50%
What is more important : Increasing GFR by glomerular hyper filtration or preventing scarring by keeping GFR low ?
PREVENTING SCARRING ...Increasing GFR is good in the short run but it is a map-adaptive consequence of CKD.
What electrolyte is important to check with anyone who is on RAAS inhibitors ?
What class of drugs should you avoid when dealing with patients with CKD ?
Why might you see anemia in CKD ?
The kidney produces erythropoietin. In CKD this is diminished due to fibrosis of specialized tubular cells that produce this.
Leads to Normochromic, normocytic anemia (Look normal, have normal B12 and iron levels. Just not enough RBC's.
What is the treatment for anemia due to CKD ?
Human recombinant Erythropoietin (EPO) (IV or sub-cue)
At what hemoglobin levels should you treat anemia in CKD ?
when hemoglobin 10
What are patients who receive Human recombinant Erythropoietin (EPO) therapy at risk for ?
Thrombosis (cardiovascular events, stroke, vascular events are also seen.)
What is the first step in activating Vit D ?
hydroxylation at the 25 position by the liver
What is the second step in activating Vit D ?
Hydroxylation at the 1 position by the kidney
What is the name of the active form of Vit D ?
Active form of vitamin D is called 1,25 Vitamin D