Clinical Reasoning-Chronic Kidney Disease Flashcards Preview

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Flashcards in Clinical Reasoning-Chronic Kidney Disease Deck (17)
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1
Q

What defines chronic kidney disease?

A

3 months or greater symptoms of eGFR < 60, albuminuria > 30mg, abnormal urine sedimentation or abnormal imaging.

2
Q

What defines end stage renal disease

A

eGFR <15

3
Q

What are the different definitions of the different stages of chronic kidney disease?

A

*

4
Q

What age group has the highest likelihood of having chronic kidney disease?

A

60

5
Q

What are the most common causes of end-stage renal disease?

A

This is likely due to people with chronic conditions living long enough to see chronic kidney disease.

6
Q

At what stages of kidney disease do you see manifestations of hypertension, bone/mineral disease, anemia, acidosis/hyperkalemia and uremia?

A

*

7
Q

How do you manage patients with CKD due to hypertension?

A

Decrease dietary sodium and put them on diuretics.

8
Q

Why are patients with CKD at higher risk for fractures and vascular calcification?

A

CKD impairs PO4- excretion and conversion of vitamin D to 1,25 active form. This stimulates PTH, causing secondary hyperparathyroidism and high-turnover of bone…weakening bone and increasing risk for fractures.

9
Q

Why has the transfusion rate for patients with CKD gone down over the past 20 years?

A

Development of recombinant erythropoietin formulas given subcutaneously when Hbg levels < 9g/dL have decreased the amount of patients who get anemic.

10
Q

Why might you consider putting a patient with CKD on oral bicarbonate supplementation?

A

CKD can impair the ability to excrete ammonium, leading to normal anion-gap metabolic acidosis. Giving oral bicarbonate would be an attempt to make the blood more basic.

11
Q

What is the most common medical emergency you see in patients with CKD?

A

Hyperkalemia is associated with sudden cardiac death.

12
Q

What population is at risk for early hyperkalemia due to CKD?

A

Diabetics. They develop early hypoaldosteronism, which decreases K+ excretion at the distal tubule.

13
Q

What medications may put your patient with CKD at risk for hyperkalemia?

A

ACE-I and aldosterone antagonists.

14
Q

What is uremia?

A

Elevation of multiple organic nitrogenous compounds, can be estimated by BUN.

15
Q

In what ways does uremia manifest itself in the CNS, CV system, bone, endocrine and constitutionally?

A

*

16
Q

A patient comes to your clinic complaining of fatigue. Lab analysis reveals a decreased hematocrit, proteinuria and elevated BUN. His eGFR is low. You diagnose the patient with stage 1 chronic kidney disease. What factors would put this patient at risk for disease progression to end-stage renal failure?

A

PKD1 (polycystic kidney disease gene), APOL1 (AA ethnicity specific), diabetes, hypertension, proteinuria and drugs (especially NSAIDs).

17
Q

What causes accelerated dropout of functioning nephrons once a kidney has been initially injured?

A

The nephrons make up for the initial loss in function by hyper filtration. This causes hypertrophy, endothelial insult and eventual fibrosis and loss of function in the originally healthy nephrons.