Flashcards in Chronic Kidney Disease Deck (80)
Over 70% of cases of late-stage chronic kidney disease are due to: 2?
12% are due to:
2. Cystic diseases
3. Other urological diseases
CKD definition according to the national Kidney Foundation?
GFR less than 60mL/min for greater than or equal to THREE months with or without kidney damage OR
Kidney damage for > or equal to THREE months with or without decreased GFR
1. Reduction in renal mass leads to what?
2. This places a burden on the remaining nephrons and leads to what?
1. hypertrophy of the remaining nephrons
2. progressive glomerular sclerosis and interstitial fibrosis
CKD Risk Factors 9
(what are the two most important?)
3. Family history of CKD
4. Patient population
5. Autoimmune disease
6. Drug toxicity
7. System infection (Shock)
8. Urinary obstruction
9. Older age
1. Normal kidney contains
2. With destruction of the nephrons, this causes what? 2
3.What two things start to show measurable increase only after total GFR has decreased by 50%
4. Plasma Cr value will approximately ______with a 50% reduction in GFR
1. 1 million nephrons
3. Blood urea and Cr
Initial Assessment of CKD:
1. Confirm primary renal diagnosis
2. Establish chronicity
3. Identify reversible factors
4. Detect co-morbid factors
5. Establish a baseline database
Staging of CKD
National Kidney Foundation
Stage 1: Kidney damage with normal or increased GFR ( (>90mL/min)
Stage 2: Mild reduction in GFR (60-89mL/min)
Stage 3: Moderate reduction in FGR (30-59mL/min)
Stage 4: Severe reduction of GFR (15-29 mL/min)
Stage 5: Kidney failure (GFR less than 15mL/min or dialysis)
Which stages are often asymtptomatic?
Clinical manifestations appear in what stages?
1. Can serum creatinine tell us all we need to know about GFR?
2. Creatinine is secreted by _____ ______; and as renal function worsens the amount secreted ________.
3, Normal ranges for serum creatinine are misleading because they do not take into account the what? 4
1. Serum creatinine alone is NOT an accurate measure of glomerular filtration rate.
2. renal tubules
-weight of the patient.
1. Measurement of Renal Function:
What formula adjusts creatinine for age, weight, and gender?
2. What is the equation?
(for men and women?)
1. The Cockcroft- Gault (CG)
CrCl (male)=([140-age] x weight in kg)/(serum Cr x 72)
CrCl (female)=CrCl (male) x 0.85
Staging of CKD
The National Kidney Foundation advises what two lab tests should be used together to assess kidney function?
GFR and Albuminuria levels be used together rather than separately to improve prognostic accuracy
What is an early parameter for measuring nephron injury and repair?
How do we measure this? 2
Microalbuminuria is a key parameter for measuring nephron injury and repair
1. Early sign of kidney disease
2. Urine dipsticks
What are the GFR stages?
1. G1 >90 -Normal or high
2. G2 60-90 -Mildly decreased
3. G3a-45-59Mild-mod decreased
4. G3b-30-44Mod to sev decrease
5. G415-29-Severely decreased
6. G5 less than 15- Kidney failure
What are the Albuminuria stages that are part of the staging of CKD?
1. A1 less than 30- Normal-mild increase
2. A2 230-300-Moderately increased
3. A3>300-Severely increased
Azotemia is what?
What can it lead to if not treated?
Condition characterized by high levels of nitrogen-containing compounds in the blood
1. Prerenal azotemia
2. Primary renal azotemia
3. Postrenal azotemia
1. WHat is uremia?
2. Symptoms may not occur until how many nephrons are destroyed?
3. Develops in which stages of CKD?
1. Condition resulting from advanced stages of kidney failure in which urea and other nitrogen containing wastes are found in the blood.
2. Symptoms may not occur until 90% of nephrons are destroyed
3. More commonly develops in the later stages of CKD
Symtpoms of Uremia:
1. General: fatigue, weakness, breath “fishy odor”
2. Skin: pruritus, easy bruising
3. ENT: metallic taste in mouth, epistaxis
4. Pulmonary: dyspnea, pulmonary edema
5. CV: dyspnea on exertion, retrosternal pain on inspiration (pericarditis)
6. GI: anorexia, N/V, hiccups
7. GU/GYN: ED, amenorrhea
8. Neuromuscular: restless legs, numbness and cramps
9. Neurologic: irritability, inability to concentrate
Signs of Uremia:
1. General: sallow appearing, chronically ill
2. Skin: pallor, ecchymosis, excoriations, edema, yellow
3. ENT: urinous breath
4. Eye: pale conjunctiva
5. Pulmonary: rales, pleural effusion
6. CV: hypertension, cardiomegaly, friction rub, displaced PMI
7. Neurologic: stupor, asterixis, myoclonus, peripheral neuropathy
What labs would we order for uremia?
1. Elevated BUN/Creatinine
4. Serum albumin levels
5. Lipid profile
Why would we order a CBC for labs for uremia?
What are we looking for with a CMP? 3
What are we looking for in the urinalysis?
WHy would we order a lipid profile?
1. Look for Anemia
1. Broad waxy cast cells
1. Risk for CVD
LABS for Uremia:
Evidence of renal bone disease can be evidenced on:
1. Serum phosphate
2. 25-hydroxyvitamin D
3. Alkaline phosphatase
4. Intact parathyroid hormone (PTH) levels
Imaging for Uremia?
1. Renal Ultrasound
-Small echogenic kidneys bilaterally
4. Retrograde pyelogram
When is renal biopsy indicated?
Major complication of this surgery?
Generally indicated when renal impairment is present and the diagnosis is unclear after extensive work-up
Metabolic complications of Uremia? 2
WHy would you see Hyperkalemia in uremia?
1. Especially when GFR drops below 10mL/min, kidneys have a decreased ability to secrete potassium
2. Can be seen sooner with potassium rich diet
3. Can get extracellular shift of potassium with acidemia and decreased insulin
Why would you get metabolic acidosis from uremia?
1. Damaged kidneys are unable to excrete the 1 mEq/kd/d of acid generated by metabolism of dietary proteins
2. This limits production of ammonia and limits buffering of H+ in the urine
3. Excess hydrogen ions are buffered by large calcium carbonate and calcium phosphate stores in the bone.
4. This contributes to the renal osteodystrophy of CKD
What are the cardiovascular complications of uremia?
2. Pericarditis: Can be complicated by tamponade
3. CHF and Pulmonary edema
4. Heart disease
-Left ventricular hypertrophy
-Ischemic heart disease
Hematologic Complications? 2
1. What kind of anemia would you expect in uremia?
2. What is this due to?
3. What other deficiency is present as well?
4. What is the coagulaopathy due to?
5. How does this affect platelets?
1. Normochromic, normocytic
2. Due to decreased erythropoietin production
3. Iron deficiency is present as well
4. Due to platelet dysfunction
5. Platelet counts are mildly decreased, but show abnormal adhesiveness and aggregation