Chronic Kidney Disease (CKD) Flashcards
(34 cards)
What is the function of the kidney?
Primary: Filtration of blood, detoxification and waste excretion, regulation of fluid and electrolyte balance, regulation of osmolarity
Secondary: acid-base balance, BP regulation, EPO regulation, and activation of vitamin D
What is CKD?
- progressive, irreversible condition in which nephron loss and compensatory changes lead to further kidney damage, systemic imbalances, and ultimately kidney failure
- process is fueled by inflammation, fibrosis, glomerular HTN, and proteinuria
How is CKD staged?
via GFR and ACR
What is eGFR?
Estimated Glomerular Rate
- the amount of blood filtered every minute by tiny filters in the kidneys called glomeruli
- measures how well the kidneys are filtering waste produced by the body
What can cause CKD? Which are the most common causes (2)?
diabetes (most common), HTN (most common), glomerulonephritis, PKD, obstructive uropathy, recurrent UTIs and pyelonephritis, or toxic exposure
What is the pathophysiology of nephron loss?
permanent damage and scarring reduce the number of functioning nephrons
What is the pathophysiology of Glomerular HTN?
increased pressure in remaining nephrons accelerates injury
What is the pathophysiology of Proteinuria?
indicated ongoing glomerular damage; promotes inflammation and further kidney injury
What is the pathophysiology of Fibrosis and Inflammation?
chronic immune activation leads to irreversible scarring
What is the pathophysiology of Uremia?
accumulation of nitrogenous wastes causes systemic toxicity
What is the pathophysiology of Electrolyte Imbalances?
impaired regulation of K+, phosphate, and calcium
What is the pathophysiological progression of DM for CKD?
microalbuminuria leads to macroalbuminuria leads to decreased GFR leads to end-stage kidney disease
What is the pathophysiological progression of HTN for CKD?
increased pressure leads to nephron loss leads to reduces kidney function leads to worsening BP control leads to vicious cycle leads to end-stage kidney disease
What are the S/S of CKD? Early stages vs Later stages
Early stages (1-3): (most often asymptomatic) fatigue, general malaise, slight swelling, urinary changes, mild HTN
Later stages (4-5): general symptoms, urinary symptoms, fluid ad electrolyte imbalance, cardiovascular, hematological, bone and mineral, neurological
What are the diagnostic tools used for CKD?
- Blood tests (serum creatinine, eGFR, BUN, CMP [electrolytes/metabolic panel], Hemoglobin & Hematocrit)
- Urine tests (urinalysis, albumin-creatinine ratio, 24hr urine collection)
- Imaging Studies (renal ultrasound, CT scan, MRI)
- Kidney Biopsy [optional] (cause of CKD unclear, provides definitive diagnosis of underlying pathology, suspected glomerulonephritis, lupus, nephritis, or rapidly progressive CKD)
What are the treatments for CKD?
- lifestyle modifications (all stages)
- dietary therapy
- medications
- management of comorbidities
- treatment of complications
- renal replacement therapies (RRTs)
- patient education and support
Medications to treat HTN related to CKD?
- ACE inhibitors
- ARBs
- Calcium channel blockers
- Diuretics
Medications to treat Proteinuria related to CKD?
- ACE inhibitors
- ARBs
Medications used to treat Diabetes related to CKD?
- SGLT2 inhibitors
- Insulin
- Oral hypoglycemics
Medications used to treat Anemia related to CKD?
- Erythropoiesis-Stimulating agents
- Iron supplements
Medications used to treat Bone Health related to CKD?
- phosphate binders
- vitamin D analogues
Medications used to treat Fluid Management related to CKD?
Diuretics
Medications used to protect CV related to CKD? (Statins)
- Atorvastatin
- Rosuvastatin
What are the effects of SDOH on patients with CKD?
- delay in diagnosis and treatment
- poor disease management
- nutritional barriers
- mental health and stress
- health disparities
