Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CRRAB II- Week 1 > Kanakiriya- CRF > Flashcards

Kanakiriya- CRF Flashcards

1
Q

What is CKD?

A

kidney damage or

GFR<60 ml/min for greater than three months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is kidney damage?

A

pathological abnormality in blood or urine tests or imaging studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the primary causes of CKD?

A 
Diabetes type 2
Diabetes type 1
HTN
glomerulonephritis
chronic interstitial nephritis and obstruction
hereditary or cystic disease
neoplasms or plasma cell dyscrasias

*70% d/t diabetes or HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the stages of CKD?

A

Kidney damage + (n) GFR >90 3.6m
Kidney damage + mild ↓ GFR 60-89 6.5m
Moderate ↓ GFR 30-59 15.5m
Severe ↓ GFR 15-29 0.7m
Kidney Failure <15 0.6m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you measure GFR?

A 
Plasma creatinine 
Cystatin C
Creatinine clearance (24hr urine)
Estimated creatinine clearance (cockroft-gault formula)
MDRD formula
CKD-Epi formula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you measure plasma clearance?

A

isotopes- iothalamate

non-isotopes- iohexol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is plasma creatine inaccurate? reduced? Raised?

A

Gold Standard- simple!

Inaccurate esp. with mild renal impairment
Reduced with LOW muscle mass
Raised with high protein meal

*affected by certain drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cystatin C? What is it not affected by? What is it affected by?

A

Low mol. Wt protein produced by all nucleated cells (will replace creatinine)

Not affected by diet, gender , age, muscle mass

Affected by steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the issue with creatinine clearance?

A
  1. Urine collections unreliable
  2. Overestimates GFR(tubular secretion of creatinine)
  3. Drug influences creatinine assays
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is used to estimate creatinine clearance?

A

Cockroft-Gault formula (gold standard)

140-Age x Wt (kg)/ 72 x S cr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the pros and cons of estimated creatinine clearance?

A

Avoids urine collection
More accurate than plasma creatinine especially with mild renal impairment

Overestimates in obesity & in low protein diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Does impaired kidney function contribute to heart disease and CVA?

A

YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is considered to be the most accurate eqtn to calculate GFR?

A

CKD-EPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is plasma clearance?

A

Best approximation to true GFR
invasive
may use radioisotopes (most accurate)–

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do kidneys do?

A 
excrete waste
regulate/excrete water and solutes
regulate AB status
secrete EPO
Ca, Phos, Vit D and bone metabolism

*1-1.3 million nephrons in each kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A pt has fatigue, type 1 DM since age 8. He also has a 3 year hx of HTN and a kidney problem. He has a high blood pressure, retinopathy, peripheral sensory neuropathy and trace peal edema and some crackles on auscultation. What does he have?

A

CKD

17
Q

What are characteristic labs of a patient with CKD?

A 
Low Hb/MCV
High plasma Glucose
elevated creatinine
elevated K 
elevated CA
Elevated Phosphorus
Low bicarb (acidotic)
Vit D (low)
PTH (high)
Proteinuria
Elevated cholesterol
elevated A1c
18
Q

How do you manage CKD?

A
  1. Treat reversible causes of renal dysfunction (approach as if they have acute renal failure)
  2. Prevent or slow progression of renal disease
  3. Treat complication of renal dysfunction
  4. Preparation and initiation of renal replacement therapy
19
Q

What are the reversible causes of renal dysfunction?

A
  1. decreased renal perfusion (pre-renal) –>Decreased fluids/dehydration/diarrhea/diuretic/vomiting/hypotension–too much BP medication
  2. Nephrotoxic drugs (MCC)- NSAIDS
  3. Urinary tract obstruction (post-renal)> prostate enlargement> relieve obstruction> kidneys get better (MC in men)
20
Q

What slows the rate of progression of CKD?**

A 
ACE inhibitors  or/and  ARBs
Treat Hypertension (<7.0)
Avoid nephrotoxic agents
         Weight control--being overweight is hard on the kidneys!
         Smoking cessation- nicotine associated glomeruluria
21
Q

What can happen to creatinine when you start someone on an ACEi and ARB?

A

Upto 25% increase in creatinine can occur within 4 weeks

Higher increased in HF, volume depleted state and bilateral RAS

22
Q

What should you monitor if you start someone on an ACEi and ARB?

A

*start w/ small dose and gradually increase the dose

Can cause hyperkalemia so should monitor creatinine and potassium

23
Q

How do you treat complications of renal dysfunction?

A 
Volume overload
Hyperkalemia
Metabolic acidosis
Hyperphosphatemia
Hyperparathyroidism (secondary)
         Anemia
24
Q

How do you treat metabolic acidosis related to CKD? What are some of the negative affects of metabolic acidosis?

A

NaBicarbonate supplementation may slow progression of CKD (1-4/day depending on bicarb level)

Constant acidotic state can cause bone buffering and can worsen bone disease

Uremic Acidosis also leads to skeletal muscle breakdown and diminish albumin synthesis

25
Q

How do you treat hyperphosphatemia related to CKD?

A

Dietary phosphorus restriction (800-1000 mg/day) (no milk, cheese, butter, nuts)

26
Q

How much Na, K, Phosphorus should you have?

A

3, 2, 1

27
Q

What should you do if a phosphorous restricted diet doesn’t work to treat hyperphosphatemia?

A

Phosphate binders

Calcium Carbonate (Tums)
Calcium Acetate (Phoslo)
Lanthanum carbonate (Fosrenal)
Sevalamer (Renagel)

Calcium Citrate
Aluminum Hydroxide
Magnesium Hydroxide

28
Q

What causes secondary hyperparathyroidism?

A

Increase in phosphorus>
decrease in Ca>
increase in PTH!

29
Q

How do you treat secondary hyperparathyroidism?

A

Calcitriol (Rocaltrol)
Doxecalciferol (Hectoral)
Paricalcitol (Zemplar)

*Downside is that they make phosphorous and Ca go up. First want to get phosphorous down then treat PTH level.

Calcimimetic—Cinacalcet (Sensipar)

*Doesn’t make Ca or phosphorous go up but it’s expensive…bummer.

30
Q

What are the steps for treating secondary hyperparathyroidism?

A

Correct Hyperphosphatemia first

Then treat sec. hyperparathyroidism with calcitriol or Vitamin D analogs

If hyperphosphatemia persists, consider Calcimimetics

Treat Vitamin D deficiency with either cholecalciferol or ergocalferol

31
Q

How do you treat anemia caused by CKD?

A

Evaluation of anemia when Hb is <10g

RBC indices, retic count, iron, ferritin, transferrin saturation, stool for hemoccults

Treat iron deficiency ( IV Preferable)
ESAs : Procrit (erythropoetin) and Aranesp (Darbepoetin)
Target Hb 10-12 g
Caution with ESA use ( CV risk)

32
Q

What do you do once kidney function is down to 20%?

A

Preparation and initiation of renal replacement therapy (RRT)

Hemodialysis (MC)
Peritoneal dialysis
Peritoneal dialysis
renal transplantation

33
Q

What has high K?

A

fruits- bananas, oranges, potatos, tomatos, melons, prunes

CRRAB II- Week 1 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions