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PHARM 343 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

(39 cards)

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1
Q

Chronic Kidney Disease Definition

A

Damage to kidney
or
GFR less than 60 for more than 3 months

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2
Q

Stage 1 CKD

A

Kidney damage with Normal GFR
- GFR greater than 90

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3
Q

Stage 2 CKD

A

Kidney damage with mild reduced GFR
- GFR 60-89

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4
Q

Stage 3 CKD

A

Moderate Reduced GFR
- 3a: GFR 45-59
- 3b: GFR 30-44

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5
Q

Stage 4 CKD

A

Severe Reduced GFR
- GFR 15-29

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6
Q

Stage 5 CKD

A

Kidney Failure / End Stage Renal Disease
- GFR less than 15 or DIalysis

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7
Q

CKD Staging Via ACR

A

ACR = Albumin:Creatinine Ratio

A1: Normal/mild increase
- ACR is less than 3.0
A2: Moderate increase
- ACR 3.0-30
A3: Severe increase
- ACR is greater than 30

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8
Q

How to assess CKD (abbreviation)

A

C: Cause
G: Glomerular Filtration
A: Albuminuria Category

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9
Q

How to evaluate for causes of CKD

A

Physical Exam
Nephrotoxic Drugs
Medical History
Family History
Social History
Symptoms and Signs (Systemic Disease)
Symptoms and Signs (Urinary Tract Abnormal)
Lab Tests

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10
Q

What are the major causes of CKD

A

1: Type 2 Diabetes

#2: Hypertension

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11
Q

What is the leading cause of death in CKD patients

A

Cardiovascular Disease

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12
Q

CKD
- Overview

A

Hypertension + T2DM causes Glomerulosclerosis
- Loss of nephron mass
- Proteinuria
- Glomerular Hypertension

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13
Q

CKD (Hypertension)
- How does it occur

A

Mainly driven by RAAS system leading to kidney injury

Vasculature
- Endothelial damage
- Endothelial cell damage
Glomerulus
- Glomerular hypertension
- Glomerular cell hypertrophy
Tubule
- Tubular damage
- Tubular cell injury
Interitem
- Inflammation
- Oxidative stress

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14
Q

RAAS System response to low BP

A
  1. Low BP
  2. JG Cells in Kidney stimulate release of renin
  3. Angiotensinogen from liver is converted by renin into Angiotensin I
  4. ACE converts Angiotensin I into Angiotensin II
  5. Angiotensin II acts on adrenal cortex to produce aldosterone and acts on arterioles to constrict
  6. BP increases
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15
Q

Angiotensin II role

A
  • Vasoconstriction
  • Increase blood pressure
  • Increases filtration of plasma protein, leads to renal scarring
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16
Q

How does Diabetic Neuropathy affect CKD

Study These Flashcards
A

Glomerular Hyperfiltration
Altered Glomerular Composition
Renal Hypertrophy
Glomerular Hypertension
Proteinuria
–> All of this leads to glomerular scarring

17
Q

Progression factors of CKD

Study These Flashcards
A

Hyperglycemia
Hypertension
Smoking
Obesity
Proteinuria

18
Q

Proteinuria and CKD

Study These Flashcards
A

Proteinuria is a strong risk factor of cardiovascular mortality
- High proteinuria = Higher risk of end stage renal disease
- Glomerular Dysfunction –> Glomerular Hyperfiltration

19
Q

Persistient Proteinuria and Transient and CKD

Study These Flashcards
A

Persistient proteinuria is an indicator of kidney damage and renal disease

Transient proteinuria can be an indicator of some sort of underlying issue (UTI, heavy exercise, dehydration, pregnancy)

20
Q

Symptoms of CKD

Study These Flashcards
A
  1. Edema/Fluid Overload
    - Glomerular Hyperfiltration causes too much proteins to go through. Reduction in kidneys filtering ability. Fluid buildup
  2. Pruritus
    - Waste is retained leading to itching
  3. Restless Leg
    - Electrolyte abnormalities
  4. Anemia
    - Kidneys do not produce erythropoietin
21
Q

CKD Lifestyle Management

Study These Flashcards
A
  1. Exercise
  2. Weight Loss
  3. Smoking Cessation
  4. Low Sodium Diet
  5. Limit Protein Intake in CKD G3-5 (Do not do if patient is metabolically unstable)
  6. Limit alcohol
22
Q

ACEi Drugs

Study These Flashcards
A

Perindopril
Ramipril
Lisinopril

23
Q

ARB Drugs

Study These Flashcards
A

Candesartan
Irbesartan
Valsartan

24
Q

When are ARBs and ACEi recommended

Study These Flashcards
A

Always use in diabetic patients (unless contraindicated)

For non diabetic patient used if ACR is greater than 3.0 (proteinuria) (unless contraindicated)

25
ACEi and ARBs mechanism
Reduces hyperfiltration Reduce glomerular hypertension (less stress on glomerulus) Reduce/stabilize proteinuria Renoprotective - Benefits are independent from BP lowering effects
26
ACEi and ARBs considerations
Do not use in AKI (Due to hemodynamic effect) Contraindications: - Pregnancy - Angioedema history - Bilateral renal artery stenosis
27
ACEi and ARBs Adverse Effects
ACEi - Dry cough ACEi and ARB - Angioedema
28
ACEi and ARB monitoring
Start with low dose and taper slowley Will get worse first before patient gets better - Serum Creatinine will spike up (due to decrease in GFR) Be careful of potassium (hyperkalemia)
29
Proteinuria - Treatment
ARBs and ACEi Can use Spironolactone in some patients (Be careful of hyperkalemia) Diltiazem and Verapamil have some effectiveness (Calcium Channel Blockers)
30
SGLT-2 Inhibitor Drugs
Empagliflozin Dapagliflozin Canagliflozin
31
SGLT-2 Inhibitor Mechanism
Renoprotective Prevents reabsorption of glucose - Lowers plasma concentration of glucose by excreting it Reduces sodium reabsorption - Sodium gets delivered to macula densa, glomerular feedback is restored, blood flow in kidney is reduced , decreases glomerular hyperfiltration, reducing intraglomerular pressure
32
SGLT-2 Inhibitors effects on patients with diabetes vs no diabetes
Reduction in glucose reabsorption mainly benefits DM Patients Reduction in intraglomerular pressure benefits both DM and non-DM patients - Dapagliflozin
33
SGLT-2 Inhibitors Considerations
Initiate as an add on therapy to ACEi and ARBs for patients with T2DM and CKD - When GFR is greater than 20 - Reasonable to keep using even if GFR falls under 20 Do not initiate in patients undergoing dialysis
34
SGLT-2 Inhibitor Adverse Effects
Genital Mycotic Yeast Infections (Due to excrerion of sugars) UTI Increased urination and thirst Diabetic Ketoacidosi - Occurs during acute illness (should put therapy on hold in this case)
35
Non-Steroidal Mineralocorticoid Receptor Antagonist drugs
Steroid MRA = Spironolactone Non-Steroidal MRA = Finerenone
36
Non-Steroidal Mineralocorticoid Receptor Antagonist considerations
Can be added on to ARB/ACEi + SGLT-2 Inhibitor - In patients with persistient albuminuria (ACR greater than 30) - In patients with normal potassium Renal and CV benefits for patients with CKD + T2DM + Greater than 25 GFR
37
GLP-1 considerations
Used to manage glycemic control in patients not responding to metformin or SGLT-2 inhibitors
38
CKD and reducing CV risk
Statins - Prescribe for all patients older than 50 with CKD - Prescribe for patients 18-49 if at moderate-high risk of CV disease ASA - Secondary prevention of atherosclerotic cardiovascular disease and ischemic CV disease
39
CKD SIckday management
If patient is ill and unable to replenish their fluids hold the following nephrotoxic drugs Sulfonylurea ACEi Diuretics Metformin ARBS NSAIDs SGLT2 Inhibitors

PHARM 343 (35 decks)

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