Chronic Kidney Disease Flashcards Preview

Renal Course > Chronic Kidney Disease > Flashcards

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

How to measure flow rates in the kidney

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


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**



Protein/albumin in urine usually Caused by glomerular hypertension

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


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



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


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


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


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


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


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

- if this occurs need to stop the ACEi/ARB


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


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

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


How to treat complications of renal disease

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

- 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

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

Anemia = erythropoietin