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Nephrology Board Review Pearls > ASN QBank Pearls - CKD and ESRD > Flashcards

ASN QBank Pearls - CKD and ESRD Flashcards

(76 cards)

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1
Q

combination of a diameter > 4 mm AND access flow > 500 mL/min predicts what success rate of use of fistula for HD?

A

95%

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2
Q

combination of fistula diameter < 4 mm AND access flow < 500 mL/min predicts what success rate of use of fistula for HD?

A

33%

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3
Q

treatment of dialysis catheter-related bacteremia with an antibiotic lock is most successful with what type of infections and what success rate?

A

gram-negative, about 90%

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4
Q

treatment of dialysis catheter-related infection with Staph epidermidis bacteremia with an antibiotic lock has what success rate?

A

about 75%

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5
Q

treatment of dialysis catheter-related infection with Staph aureus bacteremia with an antibiotic lock has what success rate?

A

about 40%

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6
Q

randomized, controlled trial, that showed giving CKD and ESRD patients LDL-lowering therapy with simvastatin and ezetimibe had a significant 17% reduction in major atherosclerotic events over 5 years of study

A

SHARP (Study of Heart and Renal Protection) trial

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7
Q
  • does alkali therapy slow progression of CKD?

- how?

A
  • yes!
  • reduces tubulointerstitial damage by limiting inflammatory urinary biomarkers such as endothelin (ET) and transforming growth factor (TGF)-β
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8
Q

the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial indicated intensive glycemic control of T2DM does not decrease incidence of

A

nephropathy and cardiovascular 
mortality

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9
Q

the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial indicated intensive BP control in T2DM was associated with

A

greater progression of nephropathy

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10
Q

patients with this condition have normalization of BP and serum K+ during pregnancy

A

primary hyperaldosteronism

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11
Q

why do patients with primary hyperaldosteronism have normalization of BP and serum K+ during pregnancy?

A

increase in progesterone levels antagonizes effects of aldosterone

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12
Q

progression of kidney disease strongly relates to the presence of two risk variants in

A

APOL1 with AR pattern of inheritance

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13
Q

diabetes medication associated with increased renal salt retention and the development of edema

A

rosiglitazone

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14
Q

cephalosporin drug accumulation does not usually occur until GFR is

A

< 30 ml/min/1.73 m2

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15
Q

cephalosporin dosing in CKD patients

A

regular loading dose then 75% of usual maintenance dose at regular intervals

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16
Q

antibiotic dosing in CKD patient with acute pyelonephritis

A

regular dosing and intervals (difficult to treat)

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17
Q

progression from CKD stage 3-4 to ESRD in ADPKD can be favorably influenced by?

A

nothing

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18
Q

resistant upper urinary tract infections in patients with PKD and CKD stage V are BEST managed by?

A

fluoroquinolones

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19
Q

what is the incidence of cerebral aneurysms in patients with ADPKD within a family cluster?

A

20%

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20
Q

in all patients with PKD, the incidence of cerebral aneurysms is close to

A

2-5%

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21
Q

cerebral aneurysms should monitored if what size?

A

5 to 10 mm

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22
Q

what size cerebral aneurysm is at higher risk of rupture?

A

> 10 mm

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23
Q

in patients with the phenotype of ADPKD, what is the second most common complication?

A

polycystic LIVER disease

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24
Q

mitral valve prolapse is present in what percentage of patients with ADPKD?

A

10-15%

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25
renal stones are present in what percentage of patients with ADPKD?
20%
26
MOST effective initial approach to increase small solute clearance in PD
add a DAY exchange
27
how many minutes in a day?
1440
28
how many minutes in a week?
10,080
29
BEST approach to management of PD patient at time of hernia repair
supine, low-volume exchanges x 4–6 weeks
30
treatment of hemoperitoneum in young, menstruating women if fluid fails to clear after in-and-out exchanges
add HEPARIN to dialysate to prevent blood from clotting
31
empiric therapy for PD-related peritonitis initially requires adequate coverage for
both gram-positive organisms and for gram-negative organisms
32
has been demonstrated to be consistently effective in reducing risk of PD-related peritonitis
daily application of antibiotic cream at PD catheter exit site
33
management of high interdialytic weight gain and high BP
limit Na+ intake (< 2 g/day) and lower dialysate Na+
34
Gibbs-Donnan effect predicts that
isonatric dialysis will only occur if the dialysate Na+ is set < the 
patient's plasma Na+ activity
35
most of the Na+ flux during hemodialysis is due to
convection
36
increase in BP during HD (intradialytic HTN) is an independent risk factor for
increased hospitalizations and death
37
LEAST effective method to manage hypotension during hemodialysis
sequential UF (isolated UF followed by HD)
38
daily HD has been shown to
- reduce systolic BP - reduce left ventricular mass - reduce death
39
dry weight reduction intervention (DRIP) trial
- challenge dry weight by 0.1/kg per treatment | - resulted in 7 mmHg lower ambulatory BP at 8 weeks compared with usual care
40
have normalizing Hb with ESAs, lowering LDL with a statin, lowering BP, or preventing intradialytic hypotension been demonstrated in RCTs in HD patients to improve survival?
no
41
what laboratory variable is the MOST closely associated with an increased probability of death in ESRD patients?
low albumin
42
depression is associated with what in ESRD patients?
increased mortality
43
which therapies have been shown to improve restless leg syndrome symptoms in HD patients?
iron therapy, short daily dialysis, and kidney transplantation
44
which therapy has NOT been shown to improve restless leg syndrome symptoms in HD patients?
erythropoiesis-stimulating agents (ESAs)
45
what can cause dementia, osteomalacia, and anemia in ESRD patients?
aluminum toxicity
46
medication associated with mental status changes when dosed excessively in a patient with CKD or AKI
ranitidine
47
medication associated with neurotoxicity when not dosed appropriately for reduced GFR
acyclovir
48
a/w severe hemolytic anemia in ESRD patients being treated for AMR
high-dose IVIG
49
dioxin toxicity in a patient with underlying kidney disease and hyperkalemia is best treated with
digoxin-specific Fab fragments
50
potential complication of high flux dialyzer membranes compared with low flux membranes
increased exposure to bacterial endotoxin
51
AC that does NOT require dose adjustment in ESRD patients
argatroban
52
an increase in which of the following is MOST likely to cause an ESA-hyporesponsive anemia by reducing iron availability for erythropoiesis in CKD and ESRD patients?
hepcidin
53
- renal infection; granulomatous inflammatory disease - MRI; poorly defined multiple low signal intensity nodules on all sequences with intervening fibrous stroma - renal histopathology; foam cells with Michelis-Guttman bodies
renal malacoplakia
54
hallmark feature on skin biopsy for calcific uremic arteriolopathy (calciphylaxis)
septal panniculitis
55
water treatment | - removes chlorine and chloramines
carbon tank
56
water treatment | - removes excess Ca++ and Mg++
water softener
57
water treatment | - removes almost everything including viruses and bacteria
reverse osmosis system
58
water treatment | - quality of dialysis water is guided by what standards?
AAMI (Association for the Advancement of Medical Instrumentation)
59
if chlorine is found in dialysis water what is the next step for the water treatment system?
rebed the carbon tanks
60
acute hemolysis in a patient on HD can occur d/t?
- overheating of water - hypotonicity d/t insufficient concentrate-to-water ratio - contamination w/ formaldehyde, bleach, chloramines, or nitrates - copper from tubing or piping
61
MCC of acute hemolysis in a patient on HD
chloramine
62
exposure of HD patients to chlorine and chloramines is a/w
- acute hemolysis - hemolytic anemia - methemoglobinemia - ESA resistance
63
exposure of HD patients to chlorine and chloramines is a/w
- acute hemolysis - methemoglobinemia - ESA resistance
64
water treatment | - removes bacteria and endotoxins
submicron filters
65
water treatment | - % rejection formula
[(feed water TDS - permeate water TDS)/feed water TDS] x 100 - TDS = total dissolved solids
66
types of peritonitis in PD patients | - occurs w/i 4 weeks of completing abx, but DIFFERENT organism
RECURRENT peritonitis
67
types of peritonitis in PD patients | - occurs w/i 4 weeks of completing abx with SAME organism
RELAPSING peritonitis
68
types of peritonitis in PD patients | - lasts > 4 weeks with SAME organism
REPEAT peritonitis
69
types of peritonitis in PD patients | - failure of effluent to clear after 5 days of appropriate abx
REFRACTORY peritonitis
70
types of peritonitis in PD patients | - peritonitis in conjunction w/ an ESI or tunnel infection with SAME organism
CATHETER RELATED peritonitis
71
if CATHETER RELATED peritonitis is d/t Staph aureus or Pseudomonas aeruginosa, what else needs to be done in addition to abx?
PD catheter replacement
72
water treatment | - SOFTENERS should be monitored how often and how?
- DAILY | - by measuring hardness of effluent water
73
water treatment | - CARBON FILTERS should be monitored how often and how?
- DAILY | - check chloramine level
74
water treatment | - RO SYSTEM AND DEIONIZER should be monitored how often and how?
- DAILY | - by measuring RESISTIVITY of effluent water
75
water treatment | - BACTERIOLOGICAL SURVEILLANCE should be monitored how often?
- WEEKLY during VALIDATION phase | - MONTHLY during SURVEILLANCE period
76
water treatment | - complete DISINFECTION of the water treatment plant should be done how often?
AT LEAST MONTHLY

Nephrology Board Review Pearls (10 decks)

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