CKD

Question 1

3 important endocrine functions of the kidneys

Answer 1

Produces erythropoietin- stimulates RBC production

Activates Vitamin D

Produces renin, which helps regulate blood pressure

Question 2

Normal BUN Values

Answer 2

10 - 20 mg/dL

Question 3

Normal Creatinine Values

Answer 3

0.5 - 1.2 mg/d

Question 4

Normal GFR

Answer 4

> 90 mL/min

Question 5

T/F BUN & Creatinine maintain a 10:1 ratio

Answer 5

True

Question 6

What is Chronic Kidney Disease(CKD)

Answer 6

Presence of kidney damage for more than 3 months with or without a GFR of < 60

Question 7

CKD has an inability to

Answer 7

Maintain acid-base balance

Remove end products of metabolism

Maintain fluid and electrolyte balance

Question 8

5 Stages of CKD

Answer 8

1
Kidney damage with normal or increased GFR
≥ 90

2
Kidney damage with mild decrease in GFR
60-89

3
Moderate decrease in GFR
30-59

4
Severe decrease in GFR
15-29

5
End stage kidney [renal] disease (ESRD)
<15

Question 9

Causes of ESKD

Answer 9

Diabetes, 50%
HTN, 30%
Glomerulo-nephritis, 10%
Other, 10%

Question 10

9 Risk factors for CKD

Answer 10

Family history and other vascular problems
Increasing age (>60)
Male
African American
HTN, 
DM, 
smoking
Overweight and obesity

Question 11

3 key characteristics of PATHO of CKD

Answer 11

Glomerulosclerosis – scar tissue in glomerulus, tissue can not filter blood properly

Interstitial fibrosis – destruction of renal tubules and interstitial capillaries

Interstitial inflammation – further damage

Question 12

What plays a major role in the process of CKD

Answer 12

Complement – inflammatory processes

Angiotensin II – increase in BP

Question 13

Clinical Manifestations of CKD by stage

Answer 13

1
Asymptomatic

2
Asymptomatic, possible HTN

3
HTN, otherwise asymptomatic

4
Manifestations becoming apparent– diagnosis often occurs here

5- ESRD
“Uremia” – Retention of many metabolic wastes

Question 14

what is uremia

Answer 14

Retention of many metabolic wastes

Urea
Creatinine
Phenols
Hormones
Electrolytes
Water

Often seen when GFR ≤ 10 mL/min

Question 15

psychologic manifestations of ESRD

Answer 15

Anxiety

Depression

Question 16

cardio manifestations of esrd

Answer 16

HTN
heat failure
coronary artery disease
pericarditis
peripheral artery disease

Question 17

gasto manifestations of esrd

Answer 17

N/V
anorexia
gastro bleeding
gastritis

Question 18

neruo manifestations of esrd

Answer 18

fatigue
H/A
sleep disturbance
encephalopathy

Question 19

ocular manifestation of esrd

Answer 19

HTN retinopathy

Question 20

pulmonary manifestations of esrd

Answer 20

pulmonary edema
uremic pleuritis
pneumonia

Question 21

endocrine/reproductive manifestations of esrd

Answer 21

hyperparathyroidism
thyroid abnormalities
amenorrhea
ED

Question 22

metabolic issues with esrd

Answer 22

card intolerance

hyperlipidemia

Question 23

hematologic issues with esrd

Answer 23

anemia
bleeding
infection

Question 24

integumentary issues with esrd

Answer 24

pruitus
ecchymosis
dry
scaly skin

Question 25

peripheral neuro issues with esrd

Answer 25

paresthesias | restless legs

Question 26

musculoskeletal issues with esrd

Answer 26

vascular and soft tissue calcification osteomalcia ostelitis fiborsa

Question 27

4 issues with abnormal kidney function and resulting clinical manifestation

Answer 27

No longer maintains F & E homeostasis ------ Edema, hyperkalemia, hyperphosphatemia, hypermagnesemia, metabolic acidosis No longer rids the body of wastes via urine -------- Anorexia, malnutrition, itching, CNS changes Decreased production of erythropoietin -------- Anemia Decreased activation of Vitamin D---------- Renal osteodystrophy

Question 28

what are CKD drugs used for

Answer 28

``` slow the rate of progression of CKD-----Reduce BP to less than 140/90 Treat hyperlipidemia (cholesterol less than 200) ``` ``` Treat the complications of CKD---------------Hyperkalemia Metabolic acidosis Hyperphosphatemia Renal osteodystrophy Anemia ```

Question 29

what drugs slow the progression of CKD by controlling BP

Answer 29

ACE or ARB Other BP meds as needed to maintain SBP (110-130) 140

Question 30

what drugs slow the progression of CKD by controlling lipids

Answer 30

Statins

Question 31

Tx volume overload in CKD

Answer 31

Loop diuretic | Used with a low-salt diet

Question 32

Tx of hyperkalemia in CKD

Answer 32

Multiple (ex. = diuretic) Addressed with hemodialysis in ESRD

Question 33

tx of metabolic acidosis in CKD

Answer 33

sodium bicarb an alkaline agent

Question 34

tx of hyperphos with ckd

Answer 34

calcium carb a phosphate binder

Question 35

tx of renal osteodystrophy with ckd

Answer 35

calcitriol activated vit D

Question 36

tx of anemia in ckd

Answer 36

erythropoietin Black box warning DVT

Question 37

Goals of therapy with sodium bicarb

Answer 37

Slow progression of CKD Prevent bone loss Improve nutritional status

Question 38

administration of sodium bicarb

Answer 38

Initiate when plasma HCO3 is < 15 mEq/mL What lab test do we use to measure this? CO2 on BMP Titrate to a HCO3 of 18-20 Consider switch to sodium citrate if bloating is a problem

Question 39

moa of calcium carb

Answer 39

bind to phosphate

Question 40

goals of calcium carb

Answer 40

keep phos levels normal | reduce mortality

Question 41

what is important with calcium carb

Answer 41

take with meals and watch for hypercalcium

Question 42

moa of calcitriol

Answer 42

Activated form of Vitamin D Stimulates intestinal absorption of calcium/phosphate and bone mineralization

Question 43

adverse effects of calcitriol

Answer 43

Hypercalcemia  | Hyperphosphatemia

Question 44

what are signs of calcium toxicity

Answer 44

GI upset, bone pain, neuro effects, cardiac arrhythmias

Question 45

Drugs of concern with complications

Answer 45

Digoxin Diabetic agents (glyburide, metformin) Antibiotics (Vancomycin) Opioids (morphine)