CKD

Question 1

SCr lab value

Answer 1

0.6 to 1.2 mg/dL

Question 2

BUN lab value

Answer 2

8 to 23 mg/dL

Question 3

CrCl lab value

Answer 3

75 to 125 mL/min

Question 4

eGFR

Answer 4

greater than 90

Question 4

Phos Lab value

Answer 4

2.5 to 4.5 mg/dL

Question 5

Ca lab value

Answer 5

8.5 to 10.5 mg/dL

Question 6

Vit D Lab value

Answer 6

20 to 50 ng/mL

Question 7

PTH NDD lab value

Answer 7

11 to 54 pg/mL

Question 8

PTH HD lab value

Answer 8

100 to 500 pg/mL

Question 9

Hb lab value

Answer 9

men – 14 to 18 g/dL
women – 12 to 16 g/dL

Question 10

TSAT lab value

Answer 10

20 to 30%

Question 11

ferritin lab value

Answer 11

200 to 500 ng/mL

Question 12

MCV lab value

Answer 12

80 to 100

Question 13

RDW lab value

Answer 13

11.5 to 14.5%

Question 14

treatment of hypertension AND CKD

Answer 14

ace inhibitors (prils)
ARBs (sartans)

Question 15

treatment of diabetes and CKD

Answer 15

SGLT2 inhibitors (flozins) and metformin

Question 16

treatment of edema from CKD

Answer 16

diuretics
dialysis

Question 17

treatment of anemia of CKD

Answer 17

iron therapy –> oral or IV
AND
erythropoietin stimulating agents (ESAs)

Question 18

treatment of mineral and bone disorder associated with CKD

Answer 18

dietary phos restriction
phosphate binders
calcimimetics
vit D

Question 19

major causes of CKD

Answer 19

diabetes mellitus
hypertension (with DM equals 60%)
glomerulonephritis

Question 20

CKD definition

Answer 20

abnormalities of kidney structure
present for over 3 months with implications for health
classification based on cause, GFR, and albuminuria category

Question 21

markers of kidney damage

Answer 21

albuminuria (AER greater or equal to 30mg/24 hr, ACR greater or equal to 30mg/g)
urine sediment abnormalities
electrolye and other abnormalities due to tubular disorders
abnormalities detected by histology
structural abnormalities detected by imagine
history of kidney transplantation

Question 22

GFR in CKD

Answer 22

below 60mL/min/1.73 m2

Question 23

GFR categories

Answer 23

G1 –> over 90 (normal)
G2 –> 60 to 89 (mildly decreased)
G3a –> 45 to 59 (mild to moderate)
G3b –> 30 to 44 (moderate to severe)
G4 –> 15 to 29 (severe)
G5 –> under 15 (kidney failure, ESKD, likely on hemodylasis)

Question 24

Crockroft and Gault formula

Answer 24

Men --> CrCl = (140 - age)*IBW / (Scr x 72) Women --> CrCl = same but multiply by 0.85

Question 25

Crockroft and Gault

Answer 25

estimation for creatinine clearance accute for patients with stable kidney function good predictor of GFR and easy to use tends to overestimate renal function in moderate to severe kidney impairment

Question 26

MDRD

Answer 26

modification of diet in renal disease formula most accurate measure of GFR

Question 27

IBW

Answer 27

men --> 50 + 2.3*(inches over 5 feet) women --> 45.5 + 2.3*(inches over 5 feet)

Question 28

AjBW

Answer 28

IBW + 0.4*(ABW-IBW) **use if patient is 130% of their IBW

Question 29

functions of the kidney

Answer 29

excrete waste products of metabolism from the blood regulate body concentration of water and salt maintain acid balance of plasma synthesize calcitriol secrete hormones

Question 30

uremia complication

Answer 30

build up of waste products in the blood associated with ESRD symptoms: increase in BUN, pruritus, confusion, NV, and anorexia

Question 31

fluid retention complication

Answer 31

edema fluid overload cardiovascular complications (increase in systemic vascular resistance/BP)

Question 32

electrolyte imbalance complication

Answer 32

metabolic acidosis hyperkalemia

Question 33

mineral and bone disorder complication

Answer 33

a complex pathway involving phos, Ca, PTH, and activated Vit D

Question 34

Anemia complication

Answer 34

Hb decreases, supplement iron and ESAs become necessary

Question 35

treatment of fluid retention (edema)

Answer 35

1. restrict fluid (but not necessary if Na+ intake is controlled) 2. diuretics (cannot be used without functioning kidneys)

Question 36

diuretic usage for edema

Answer 36

used to treat volume overload and HTN in patients with renal insufficiency or those that are making some urine use thiazide if CrCl is over 30mL/min, use loop if under if renal function declines and loop is maxed, may add a thiazide to overcome resistance

Question 37

treatment of Na imbalance

Answer 37

1) no salt added diet, under 2g of Na per day or under 5g of NaCl per day (make sure outpatient aware of hidden high sodium content foods like canned soup or hot dogs) 2) saline containing IV solution (maybe)

Question 38

treatment of K imbalance

Answer 38

restrict to 3 gm/day 1) avoid high potassium foods like tomatoes 2) treatment for hyperkalemia

Question 39

treatment of hyperphosphatemia

Answer 39

problem for nearly all ESRD patients 1) phosphate binders 2) dietary restrictions

Question 40

CKD-MBD

Answer 40

increases Phos, decrease Ca, decrease Vit D --> signals the pituitary gland to release parathyroid hormone --> pull Ca back into the blood from the bone --> increased risk of fractures

Question 41

phosphate binders

Answer 41

bind dietary phosphate which is ingested in the food and the chelate is eliminated in the feces can either contain calcium or not contain calcium do not give them calcium containing phos binders if they have normal level calcium! all must be given with meals or they will not work

Question 42

calcium containing phosphate binder drugs

Answer 42

calcium carbonate (tums) - 40% elemental calcium calcium acetate (phoslo) - 25% elemental calcium

Question 43

calcium carbonate (tums)

Answer 43

calcium containing phosphate binder whatever is happening in the blood will be absorbed in the GI tract and worsen the problem SE -- constipation do not exceed 1500 mg elemental calcium

Question 44

calcium acetate (phoslo)

Answer 44

will bind twice as much phosphate in comparison to tums may produce fewer hypercalcemic events when compared

Question 45

non calcium containing phosphate binder drugs

Answer 45

sevelamer carbonate (renvela) lanthanum carbonate (fosrenol) sucroferric oxyhydroxide (velphoro) auryxia (ferric citrate) alumnium hydroxide (amphojel) magnesium carbonate (mag-carb) nictonic acid and nicotinamide

Question 46

sevelamer carbonate (renvela)

Answer 46

if phos is between 5.5 to 7.5, 800mg TID if phos is greater than 7.5, 1600mg TID SE -- GI upset, NVD decreased LDL by 15 to 30% decrease uric acid serum conc (good for gout)

Question 47

sucroferric oxyhydroxide (velphoro)

Answer 47

needs to be titrated with 1 tablet per day each week SE -- darkened stool due to iron content (but minimal effect on iron)

Question 48

lanthanum carbonate (fosrenol)

Answer 48

dose - 250 to 750mg TID (but can titrate up to max 1500 to 3000 mg per day) eliminated in feces with no long term accumulation

Question 49

auryxia (ferric citrate)

Answer 49

for CKD patients on dialysis increases TSAT, increases ferritin

Question 50

aluminum hydroxide (amphojel)

Answer 50

only short term usage less than 4 weeks never really used, most of the time theres a better option (potential for aluminum toxicity)

Question 51

dietary restriction for hyperphosphatemia

Answer 51

intake should be restricted to 800-1000mg per day if phos is above 4.6 in CKD stage 3/4 and above 5.5 in CKD stage 5 and PTH is greater than target range for stage 3, 4, or 5

Question 52

foods that contain high phos

Answer 52

least to most beer cola shrimp peanut butter chicken thigh frozen pepperoni pizza slice milk 1% Mcdonalds cheeseburger bacon egg cheese biscut