Chronic Kidney Disease Flashcards Preview

Renal Course > Chronic Kidney Disease > Flashcards

Flashcards in Chronic Kidney Disease Deck (12)
Loading flashcards...
1

How to measure flow rates in the kidney

GFR of the kidney
- this is the value used to determine chronic kidney disease for certain

2

Why is creatinine not the best determinant of GFR?

Creatinine can be influenced very easily by muscle mass, increased/decreased meat intake and age

**it is still good to use, just not by itself**

3

Proteinuria

Protein/albumin in urine usually Caused by glomerular hypertension

In chronic kidney disease, the quantity of proteinuria is strongly correlated to mortality rates

4

What are the top 3 casues of CKD in the US?

Hypertension

Diabetes

Acute kidney injuries (severe acute episodes or repeated mild acute kidney injuries)

5

Pre-renal causes of AKI

Hypovolemic states
- hypotension
- acute hemorrhage
- diarrhea

Congestive Heart Failure (CHF)
- **seems counterintuitive since CHF leads to hypervolemia and edema, however actually causes intravascular hypovolemia and decreased kidney perfusion

Vascular alterations limiting glomerular flow
- overuse of NSAIDs
*constricts the glomerular afferent arteriole

- overuse of ACEi’s/ARBs
*dilates efferent > afferent. = lower GFR

- use of radiocontrast
*constrict afferent arteriole

6

Intrinsic renal causes of AKI

Glomerular diseases
- nephrotic and nephritic syndromes

Acute tubular necrosis
- ischemia and exposure to nephrotoxicity

Acute interstital nephritis
- mostly by overuse of medications

Renal vascular diseases
- TTP/HUS/polyangitis/ thrombosis

7

Post renal causes of AKI

Any obstruction of the urinary tract that blocks urinary flow
- prostate cancer and benign prostate Hypertrophy are the most common
- kidney stones are next

8

Treatment of CKD

1st step is always to identify and treat any underlying causes
- usually diabetes and HTN
- stop nephrotoxicity medications

2nd step is to protect the nephrons (these dont regenerate)
- avoid any causes of decreased kidney perfusion. Includes hypovolemia, hypotension, GFR-lowering drugs (DONT over treat HTN and avoid NSAIDs)
- also avoid very high doses of ACEi/ARBs as best as possible (they do still provide benefits in step 3 however)
- avoid radioconstrast dyes

3rd step is to include protective measures
- prevents excess increases in intraglomerular pressure
- this includes use of ACEi/ARB in low doses (dilates efferent arterioles and lowers glomerular pressures)
- also stop smoking, restrict proteins in diet and treat metabolic acidosis if it arises

9

What is the #1 ADR to watch for in CKD patients who are started on ACEi/ARB

Hyperkalemia
- if this occurs need to stop the ACEi/ARB

10

Complications of CKD and treatments

1) Metabolic acidosis
- bicaronate supplementation with careful monitoring

2) Volume overload
- restrict sodium
- diuretics (usually loop)
- compression stockings

3) hyperkalemia
- restrict potassium
- AVOID NSAIDs and ACE/ARBs if present

4) bone and mineral disorders (usually hyperphosphatemia)
- restrict phosphate
- vitamin D3 supplementation

5) hypertension
- loop diuretic or ACEi/ARB (use clinical judgement)
- need to try to get BP to 120-130/<80

6) anemia
- give erythropoietin supplements

7) dyslipidmeia and sexual dysfunction
- give statins and drugs for sexual dysfunction as long as it is medically safe to do

11

What is the time cut off between acute vs chronic kidney disease?

3 months
- less than 3 months = Acute
- greater than 3 months = chronic

12

How to treat complications of renal disease

Volume overload
- sodium
- diuretics (usually loop and need to be careful with dosing)
- compression stockings

Hyperkalemia
- low potassium diet
- avoid NSAIDs and ACEi/ARB is hyperkalemia is high.

Metabolic acidosis
- bicarbonate supplements

Bone and mineral disorders
- Dietary phosphate restriction
- phosphate binders
- vitamin D3 supplementation

HTN
- loop diuretics and ACEi/ARB (be careful with hyperkalmei)

Anemia = erythropoietin