Module 11.1 - Chronic Kidney Disease Flashcards
1
Q
What is chronic kidney disease?
A
The presence of renal damage, which is characterized by decreased kidney function (GFR< 60 mL/min/1.73m2 for three (3) or more months, irrespective of the cause OR the presence of kidney damage, detected by urinary albumin excretion of > 30mg/day
2
Q
What is creatinine?
A
- Creatinine is a chemical waste product produced by skeletal muscle metabolism.
- Serum creatinine measures the level of creatinine in your blood.
- A urine creatinine clearance approximates the glomerular filtration rate (GFR)
- An increase in creatinine from 1 to 2 mg/dL is typically seen with a 50% loss of kidney function
3
Q
What causes chronic kidney disease?
A
- Associated with a history of HTN
- Bilateral small kidneys on ultrasound examination
- Renal osteodystrophy noted on plain x-rays of kidneys
A disease that causes CKD:
- Glomerular disease
- Polycystic kidney disease
- Hypertensive nephropathy
- Diabetic nephropathy
- Obstructive nephropathies
- Renal artery stenosis
- Tubulointerstitial nephritis or necrosis
4
Q
What are the characteristics of stage V chronic kidney disease?
A
- End-stage renal disease
- GFR < 15 ml/minute or dialysis dependent
- Uremia and cardiovascular disease
- Monitor GFR. Normal is 80-120ml/min
- Renal replacement indicated when GFR falls to 5-10ml/min
- Indications for emergent dialysis consists of above and patient presenting symptoms- fluid overload, hyperkalemia, acidosis
5
Q
What are the chronic kidney disease stages?
A
6
Q
What are the signs/symptoms of CKD?
A
- Fatigue/Weakness
- Skin: Pruritus, bruising, excoriations, edema
- ENT: epistaxis, ruinous breath, metallic taste in mouth
- Pulmonary: Shortness of breath, rales, pleural effusion
- Cardiovascular: Dyspnea on exertion, pericardial friction rub (due to pericarditis r/t uremia), hypertension (r/t volume overload), cardiomegaly
- Gastrointestinal: anorexia, nausea/vomiting
- Genitourinary: impotence, nocturia, Iso-osmolar urine
- Neurologic: irritability, inability to concentrate, decreased libido, stupor, asterixis, peripheral neuropathy (r/t diabetes, if present), restless leg syndrome, anemia (r/t erythropoietin deficiency)
7
Q
How do you manage fluid overload associated with CKD?
A
- Monitor weight, BP, urine Na+ excretion, Cr. Cl and serum Creatinine
- Decrease Na+ and fluid intake
- Diuretics, starting with Furosemide 20-80mg/day
- Other diuretics as warranted, such as Metolazone, Chlorothiazide, Bumetanide
8
Q
How do you manage hypertension associated with CKD?
A
- Determine the patient’s optimal Na+ and H2O balance. Avoid excess.
- Antihypertensive agents to maintain renal blood flow and reduce glomerular pressure and proteinuria
- If proteinuria is present, consider ACE inhibitors and calcium blockers.
- Antihypertensives: Goal BP for patients with chronic renal failure is < 140/80; for those with proteinuria greater than 1-2 grams, if is < 125/75mm Hg
- Consider ACE inhibitors, ARBs, CCBs, Direct vasodilators, Peripheral alpha blockers, Beta blockers, central alpha blockers (in this order)
9
Q
How do you manage protein catabolism associated with CKD?
A
- Common presenting symptom in CKD is persistent proteinuria
- Limit protein intake to < 8 grams/kg/day
- Provide adequate calories
- Thyroid hormone, steroids and tetracycline increase catabolism and should be AVOIDED
10
Q
How do you manage acidosis associated with CKD?
A
- Alkalizing agents are indicated when plasma HCO3 is <20mEq/L
- Sodium citrate (Bicitra or Shohl’s solution) 1mEq/mL of Na+
11
Q
How do you manage hyperkalemia associated with CKD?
A
- Avoid foods and medications high in K+
- Avoid hypercatabolic states
- Medical emergency is K+ is > 7 mEq/L
- Calcium gluconate or CaCl IV for myocardial irritability
- Correct acidosis
- Administer K+ ion exchange resins, such as Kayexalate 30-60gms/day
- Hemodialysis
- Monitor EKG for flat P waves, peaked T waves, PR interval > 0.20 seconds, QRS complex > .10 second and bradycardia
12
Q
How do you manage hyperphosphatemia associated with CKD?
A
- Phosphorous level should be kept < 4.6 mg/dL
- Restrict phosphorus, such as colas, eggs, dairy, and meat
- GFR < 20-30 mL/minute requires phosphate binding agent
- Calcium carbonate 650mg tid is a phosphate binding agent and prevents aluminum toxicity
13
Q
How do you manage anemia associated with CKD?
A
- Iron supplementation
- Vitamin supplementations prn
- Erythropoietin weekly injections- recommended therapy for patients who have started dialysis and have a hemoglobin level of < 10g/dL
- Rarely red blood cell transfusion
14
Q
How do you manage hypocalcemia associated with CKD?
A
- Maintain phosphorous level at < 6 mg/dL
- Calcium carbonate supplements
15
Q
How do you manage renal osteodystrophy associated with CKD?
A
- Prevent acidosis, hypocalcemia, hyperphosphatemia, control hyperparathyroidism if present
- Correct low Ca (< 6.5 mg/dL)
- Correct high phosphorous levels (>5mg/dL)
- Administer Vitamin D if Ca stays < 6mg/dL
- Identify and treat hyperparathyroidism which is triggered by low calcium levels.
