Exam 2 lecture 4 Flashcards Preview

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Flashcards in Exam 2 lecture 4 Deck (36):
1

CKD chronicity

>3 months

2

CKD chronicity

>3 months

3

how often is CKD progression assessed?

annually ( more often in high risk)
- GFR
-albuminuria

4

RAAS inhibition is

- renoprotective
- BP decrease
- albuminuria decrease

5

T2DM CKD ND pts

- urine albumin lowered w/out significant BP reduction= renoprotective
- no urine albumin lowering with significant BP lowering = no renoprotection

6

T2DM CKD ND pts

- urine albumin lowered w/out significant BP reduction= renoprotective
- no urine albumin lowering with significant BP lowering = no renoprotection

7

50% additional renoprotection when

titrated to max albumin reduction

8

50% additional renoprotection when

titrated to max albumin reduction

9

prevent CKD progression

- BP management/RAAS interruption
- protein intake
- glycemic c ontrol
- salt intake

10

management of CKD progression

- review current management
-examine for reversible causes of progression
- consider referral to a specialist

11

management of CKD progression

- review current management
-examine for reversible causes of progression
- consider referral to a specialist

12

non-diabetic CKD ND treat to

- urine albumin excretion 140mmHg SBP or >90mmHg DBP
- ACEI/ARB recommended

13

non-diabetic CKD ND treat to

- urine albumin excretion >30mg/24hr
- BP consistently >130mmHg SBP or >80mmHg DBP
- ACEi/ARB recommended

14

non-diabetic or diabetic CKD ND treat to

- urine albumin excretion 140mmHg SBP or >90mmHg DBP
- ACEI/ARB recommended

15

non-diabetic or diabetic CKD ND treat to

- urine albumin excretion >30mg/24hr
- BP consistently >130mmHg SBP or >80mmHg DBP
- ACEi/ARB recommended

16

non-diabetic or diabetic CKD ND treat to

- urine albumin excretion >30mg/24hr
- BP consistently >130mmHg SBP or >80mmHg DBP
- ACEi/ARB recommended

17

blood pressure control in CKD

- initiate low dose, then titrate at 4 week intervals
- increase until proteinuria decreased 30-50% or side effects (hyperK, >SCr)
- antiproteinuric effects not necessarily same doses as antiHTN effects

18

combo of ACEI/ARB

- increased risk in progression of renal impairment
- decreased proteinuria
- do not use togetehr

19

combo of ACEI/ARB

- increased risk in progression of renal impairment
- decreased proteinuria
- do not use togetehr

20

CCBs in CKD

- Non-DHP CCBs: beneficial on proteinuria; use when ACEI/ARB not tolerated
- DHP: no added benefit besides BP control

21

CCBs in CKD

- Non-DHP CCBs: beneficial on proteinuria; use when ACEI/ARB not tolerated
- DHP: no added benefit besides BP control

22

ACEI & nonDHP combo

- increased efficacy in reducing proteinuria
- more studies needed

23

aliskiren for BP in CKD

- not recommended
- increased risk of stroke & adverse effects
- contraindicated with ACEI/ARB in DM

24

aliskiren for BP in CKD

- not recommended
- increased risk of stroke & adverse effects
- contraindicated with ACEI/ARB in DM

25

modification of diet in renal disease (MDRD)

-protein (phosphorous) restriction
-

26

modification of diet in renal disease (MDRD)

-protein (phosphorous) restriction
- KDIGO: 0.8g/kg/day for GFR1.3) in adults with CKD at risk for progression
- difficult to be compliant

27

modification of diet in renal disease (MDRD)

-protein (phosphorous) restriction
- KDIGO: 0.8g/kg/day for GFR1.3) in adults with CKD at risk for progression
- difficult to be compliant

28

diabetic CKD treatment

- target A1C~7%
- pts at risk of hypoglycemia, do not treat 7% in pts with comorbidities, limited life expectancy & risk of hypoglycemia.

29

diabetic CKD treatment goals

- target A1C~7%
- pts at risk of hypoglycemia, do not treat 7% in pts with comorbidities, limited life expectancy & risk of hypoglycemia.

30

diabetes control & complications trial (DCCT)

- showed long-term benefits of intensive insulin therapy
- decreased microalbuminuria & albuminuria
- higher hypoglycemia

31

ACCORD

-intensive therapy

32

intensive glucose control

- don't do it
can't treat a dead pt

33

intensive glucose control

- don't do it
can't treat a dead pt

34

salt intake

-

35

high sodium intake

- increases BP
- increases proteinuria
- induces glomerular hyperfiltration
-blunts the response to RAAS blockade

36

complications of ESRD

- anemia
- CVD
- renal bone disease
- potassium homeostasis
- acidosis
-volume overload/edema