Chronic Kidney Disease

Question 1

What is the definition of CKD?

Answer 1

Presence of kidney damage or dec kidney function for 3 or more months irrespective of cause.

Question 2

The presence of what signs suggest Kidney Damage?

Answer 2

Albuminuria
Urinary sediment Abn RBC/WBC casts
Electrolyte and other abn
Imaging abn PCKD, Hydronephrosis, echogenic kidn
Kidney biopsy
Kidney transplant

Question 3

What defines decreased kidney function?

Answer 3

eGFR below 60mL/min per 1.73m2

Question 4

WHat genes are associated with Faster ESRD incident rates?

Answer 4

APOL1 gene

Question 5

WHat are the sociodemographic factors that predispose to CKD?

Answer 5

Older age
Af Am, Am Indian, Hispanic, Asian, PIsl
Exposure to certain chemicals
Low income/education

Question 6

What are the exogenous filtration markers used to estimate GFR? Properties?

Answer 6

Inulin(GS), Lothalamate, iohexol

100% filtered, not secreted or absorbed

Question 7

What are the endogenous filtration markers used to estimate GFR?

Answer 7

Creatinine, cystatin C, BUN

Question 8

What are the GFR Estimation equations?

Answer 8

Cockcroft -Gault
MDRD study equations (better @ low funct)
CKD EPI (better @ high funct)

Question 9

What eGFR equates to Stage 1 CKD?

Answer 9

less than 90 mL/min

Question 10

What eGFR equates to Stage 2 CKD?

Answer 10

89-60 mL/min

Question 11

What eGFR equates to Stage 3 CKD?

Answer 11

59-30 mL/min

Question 12

What eGFR equates to Stage 4 CKD?

Answer 12

29- 15mL/min

Question 13

What eGFR equates to Stage 5 CKD?

Answer 13

less than 15 mL/min

Question 14

How is Stage 3 CKD divided?

Answer 14

G3a= 45-59
G3b= 30-44

Question 15

What is microalbumin?

Answer 15

UA comes back negative for protein, you will check for a further test to assess for microscopic amounts of protein.

Question 16

What combination of factors increase someone’s risk of CKD?

Answer 16

Lower GFR

Higher albumin lost in urine

Question 17

What are the compensatory changes seen in CKD progression?

Answer 17

Increased intraglomerular pressure

Inc in filtration in the preserved nephrons

Question 18

What maladaptive changes cause decline in GFR?

Answer 18

Direct endothelial cell damage
Subendothelial hyaline deposits
Inc strain on the mesangial cells => release in cytokines(TGF-Beta, PDGF=> mesangial expansion)

Question 19

What are secondary factors for CKD progression?

Answer 19

Proteinuria by:

• Mesangial toxicity
• Tox from filtered transferrin/iron and albumin bound FA
• Proinflammatory molecules (MCP) and cytokines

Question 20

How can CKD progression be evaluated?

Answer 20

Assess GFR and Albuminuria annually

Assess more often if at higher risk of progression or if it will impact Therapy.

Question 21

What is Azotemia?

Answer 21

Presence of nitrogenous waste products in the blood. Elevated BUN and Creat

Question 22

What is Uremia?

Answer 22

Azotemia + S and S of Renal Failure

Question 23

If the UA is positive for Protein, what other labs do you want to order? Negative?

Answer 23

BUN and Creatinine

Microalbumin

Question 24

What are the complications of CKD?

Answer 24

Cardiovascular(MI)***
pulm
neuro
psych
etc

Question 25

What is the #1 Cause of death in CKD patients?

Answer 25

Cardiovascular Disease

Question 26

What are Bone complications of CKD?

Answer 26

Abnormalities of Ca, Phos, PTH or VD mets | Extra Skeletal Calcification

Question 27

What is Calciphylaxis?

Answer 27

Extraosseus calcification of the arterioles => ishchemia and Necrosis

Question 28

What is the management of CKD?

Answer 28

``` Tx of reversible causes Prev or slow progression Tx of complications Adjust drug dose for eGFR ID and prep Pts in need of Renal replacement ```

Question 29

What are the reversible factors of CKD?

Answer 29

``` Meds- NSAIDS/ACEI/ARB/ Radiocontrast Vol depletion Infection Obs of urinary flow HTN CHF/Pericardial Tamponade Hypercalcemia ```

Question 30

How can progression of CKD be slowed down?

Answer 30

``` interrupt the process of Maladaptive Hyperfiltration*** ACEI/ ARB/ Aldo antagonists/ renin inh Red Proteinuria- Meds/diet Control BP Diet- low protein/low phos Tx dislipidemia and Smoking Tx Mets acidosis ```

Question 31

What is the Goal BP for a Pt with CKD?

Answer 31

less than 140/90 if Albumin ex 30mg/24hrs

Question 32

At which stage of CKD do complications begin to appear?

Answer 32

Stage 3

Question 33

How is CKD related volume overload treated?

Answer 33

Salt and water restriction | Diuretic therapy-loop diuretic

Question 34

Why do patients with CKD sometimes present as anemic? | Treatment?

Answer 34

Less EPO production from the kidney | EPO stimulation agents

Question 35

What is the cause of CKD related Hyperkaliemia? Tx?

Answer 35

Metabolic Acidosis | Treat with Low K diet, diuretics and alkali

Question 36

What are the features of Hyperphosphatemia in CKD?

Answer 36

Occurs early and leads to 2^ HyperPTH Uremic Toxin! CKD => Dec Vit D prod and hypocalcemia Restrict Phos in diet give phos binders and calcimimetics

Question 37

What subtances need to be avoided in Pts with CKD?

Answer 37

Radiocontrast Gandolinium-based contrast Bowel preparation

Question 38

What are rhe Tx options for CKD Stage 5?

Answer 38

Maint Hemodialysis Peritoneal Dialysis Kidney Transplant Palliative Care

Question 39

When should Pts with CKD be referred to a specialist?

Answer 39

AKI or sustained fall in GFR | Urinary Casts