Chronic Kidney disease and end stage renal disease (Dr. Shepler) Flashcards Preview

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Flashcards in Chronic Kidney disease and end stage renal disease (Dr. Shepler) Deck (35)
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1

Chronic Kidney Disease (CKD) definition

progressive loss in renal function over a period of months or years (defined as abnormalities of kidney structure, present for >3 months with implications for health)

2

End Stage Renal Disease (ESRD) definition

the last stage of chronic kidney disease, when the kidneys can no longer support the body's needs. Dialysis or transplant is needed to stay alive

3

3 major causes of CKD

diabetes mellitus
hypertension
glomerulonephritis

4

Other causes of CKD

polycystic kidney disease PKD
HIV nephropathy

5

CDK classified based on

cause
GFR
albuminuria category

6

Criteria for CDK

either of the following following present for >3 months
*Markers of kidney damage (one or more):
-albuminuria (AER>=30mg/24hrs; ACR>=30mg/g)
-urine sediment abnormalities
-electrolyte and other abnormalities due to tubular disorders
-abnormalities detected by histology
-structural abnormalities detected by imagine
-history of kidney transplantation
*Decreased GFR: GFR<60ml/min/1.73m2 (GFR cat. G3a-G5)

7

AER

albumin excretion rate

8

ACR

albumin to creatinine ratio

9

G3a GFR

45-59 Mildly to moderately decreased

10

G3b GFR

30-44 moderately to severely decreased

11

G4 GFR

15-29 severely decreased

12

G5 GFR

<15 kidney failure

13

Albuminuria category A1

<3mg/mmol (ACR)

14

Albuminuria category A2

30-300mg/24hrs (AER) 3-30mg/mmol (ACR)

15

Albuminuria category A3

>300mg/24hrs (AER) >30mg/mmol (ACR)

16

Cockroft and Gault equation men

CrCl=(140-age)IBW/(Scr x 72)

17

Cockroft and Gault equation women

CrCl= men x 0.85
CrCl= 0.85{(140-age)IBW/(Scr x 72)}

18

Cockroft and Gault formula for estimating GFR in:

accurate for patients with stable kidney function
good predictor of GFT and easy to use
tends to overestimate renal function in moderate to severe kidney impairments (counts secretion when only want filtration)

19

MDRD formula

(modification of diet in renal disease) most accurate measure of GFR, includes adjustments of race and gender

20

IBW males

50+2.3(inches over 5 feet)

21

IBW women

45.5+2.3(inches over 5 feet)

22

Adjusted body weight

IBW+0.3(TBW-IBW)

23

Complications of kidney disease

-Build up of waste products in the blood
-Edema, fluid overload, cardiovascular complications
-Metabolic acidosis
-Anemia
-Mineral and bone disorder (increase in PTH)

24

Build up of waste products in blood signs

increased BUN
pruritus (skin itching)
confusion
nausea, vomiting
anorexia

25

diuretic resistance how happens

loops block Na/Cl/K transporters in ascending thick loop, hypertrophy of distal cells
-overcome with thiazides

26

thiazides ineffective when

CrCl <30ml/min

27

Na in CKD:

-no need to severely sodium restrict beyond no salt added diet (so<5g NaCl per day)
-use saline containing IV solutions with caution
-make outpatients aware of hidden high sodium foods

28

K in CKD

-restrict to 3gm/day

29

K goal pre-dialysis

4.5-5.5mEq/L

30

High potassium foods:

tomatoes
dried fruits
salt substitutes
fresh fruits