Chronic Kidney Disease Flashcards
(42 cards)
Why should we caution against using serum creatinine alone as a measure of kidney function?`
Serum creatinine amounts changes depending on the person’s muscle mass (more muscle –> more creatinine). So some people may have more or less than the “normal” range in the clinical setting.
How can we account for difference between people when measuring serum creatinine as a measure of GFR?
Put the serum creatinine into 1 of the 3 biometric equations
Cockroft Gault, MDRD, CKD-EPI
What is the official definition of Chronic Kidney Disease?
A structural or functional abnormalities for more than 3 months as manifested by either a decrease in GFR OR other kidney damage types
What is the GFR cutoff for diagnosing CKD?
GFR <60 ml/min/1.73m2
If you have a kidney transplant does that classify you as having CKD?
Yes, if you have a kidney transplant you are considered to have CKD.
Staging of CKD is based solely off of the…?
GFR
Describe the GFR at each stage of CKD:
Stages 1-5.
Stage 1: >90 Stage 2: 89-60 Stage 3a: 59-45 Stage 3b: 30-44 Stage 4: 15-29 Stage 5: <15
Explain why CKD stage 1 has a GFR that’s above 60.
Stage 1 CKD has a GFR >90 which is normal, but there can be a structural abnormality with the kidney that leads to this classification (ie. microalbuminuria)
How much of the medicare budget is spent on CKD?
20% despite CKD making up 1/10 of the medicare population.
It’s very expensive to care for CKD.
What is the most common cause of CKD? The second?
- Diabetes
2. Hypertension
What are major organ systems affected by CKD?
Cardiovascular - greatly affected Neurologic Hematologic Bone Mineral Metabolism Electrolytes and Volume Status
How does CKD affect renal sodium handling?
CKD decreases the kidney’s ability to secrete or resorb sodium.
Prone to developing hypovolemia and hypervolemia
In CKD we typically recommend patients decrease____ and ___ intake.
sodium and water
Potassium handling is primarily mediated by…?
Aldosterone
More aldosterone = Less K+
What do recommend to patients in regards to potassium when they have CKD?
Limit potassium intake
Avoid medications that cause hyperkalemia (bactrim)
What is the major type of metabolic acidosis in CKD patients? NAGMA or AGMA?
NAGMA - Decreased Ammonia production in the proximal tubule leads to increased H+ floating around in the blood because there isn’t enough ammonia to bind it.
In CKD patients with Metabolic Acidosis we recommend..
Sodium bicarbonate supplementation.
In addition to “GOLDMARK,” two other causes of AGMA are…?
Phosphate and Sulfate Retention
The Kidney uses alpha 1 hydroxylase to convert….?
25 hydroxy Vit D (inactive) –> 1, 25 hydroxy VitD (active calcitrol)
What are the 3 treatment options for Renal Osteodystrophy (Secondary hyperparathyroidism)?
Give Phosphate Binders - FIRST THING!
Give 1,25 Hydroxy Vit D (Calcitriol) – Brings up serum Ca2+
Use PTH inhibitor - save bones!
Describe the effect CKD has in the progression of anemia. (3)
- Inflammation –> Iron cannot be incorporated well into the RBC’s
- Decreased EPO –> Less RBC’s
- Decreased RBC life span
Describe the effect CKD has on platelets.
Platelet dysfunction
Poor platelet adhesion - predisposition to bleeding
Toxin Retention
How do you treat platelet dysfunction in the setting of CKD? (2)
DDVAP (Desmopressin)
Dialysis - if severe
How do you treat anemia in the setting of CKD? What is the goal?
Use EPO stimulating agents.
Goal Hgb is 10-12g/dL
If you go over 12 you can cause stroke or HTN.
