Week 3: CKD

Question 1

What is CKD?

Answer 1

Involves the progressive, irreversible loss of kidney function

Question 2

How KDOQI define CKD?

Answer 2

either kidney damage or GFR less than 60mL/min/1.73 for 3 months or longer

Question 3

What is end-stage renal disease?

Answer 3

stage 5 which is advanced renal disease where the GFR is less than 15 mL./min/1.73

Question 4

What is uremia?

Answer 4

a constellation of signs and symptoms resulting from the buildup of waste products and excess fluid associated with kidney failure

Question 5

What signs/symptoms are associated with uremia?

Answer 5

elevated serum creatinine and BUN, abnormal electrolytes, acidosis, anemia, fluid volume excess, nausea, loss of appetite, fatigue, decreased cognition, pruritis, neuropathy

Question 6

What is one of the most important risk factors in the progression of CKD?

Answer 6

Proteinuria

Question 7

How do we measure proteinuria?

Answer 7

Protein to creatinine ratio or albumin to creatinine ratio

Question 8

What information can be obtained from a urinalysis?

Answer 8

Measurement of RBCs WBCs protein cases and glucose

Question 9

What role does ultrasound play in CKD

Answer 9

Determine the size of the kidneys and rule out potential of obstruction

Question 10

What is the preferred measure to determine kidney function?

Answer 10

eGFR

Question 11

Why would a patient need a renal biopsy?

Answer 11

to provide a definitive diagnosis

Question 12

What occurs in the urinary system with CKD?

Answer 12

polyuria from inability to concentrate urine (nocturia is most common)

Question 13

What is Olguria?

Answer 13

< 400mL/day

Question 14

What is Anuria?

Answer 14

<40 mL/24 hr)

Question 15

What occurs in the metabolic system with waste product accumulation

Answer 15

as GFR decreases BUN and creatinine increases

Question 16

Metabolic system and altered carbohydrate metabolism

Answer 16

cellular insensitivity to insulin = defective carb metabolism

Question 17

Metabolic system an elevated triglycerides

Answer 17

hyperinsulemia stimulates triglyceride production

Question 18

What acid base imbalance occurs with Potassium?

Answer 18

hyperkalemia from decreases excretion

Question 19

What acid base imbalance occurs with Sodium?

Answer 19

hyponatremia from sodium retained with water (it’s peed out)

Question 20

What acid base imbalance occurs with Magnesium?

Answer 20

Hyper magnesia from impaired excretion

Question 21

What acid base imbalance occurs with metabolic acidosis?

Answer 21

from the inability to excrete acid load

Question 22

What hematological changes occur with anemia?

Answer 22

decreases erythropoietin production by kidneys = decreased bone marrow stim to release RBCs

Question 23

What hematological changes occur with bleeding tendencies

Answer 23

Qualitative defect in platelet function

Question 24

What hematological changes occur with infection?

Answer 24

changes in leukocytes/immune response = increased susceptibility

Question 25

What cardiovascular changes occur with CKD?

Answer 25

HTN most common

Question 26

what do increased triglycerides do?

Answer 26

rapid atherosclerosis

Question 27

What respiratory changes occur with CKD?

Answer 27

dyspnea, edema, pleuritis, pleural effusion from fluid

Question 28

What GI changes can occur with CKD?

Answer 28

every part affected from excess urea N/V/anorexia/mal nutrition

Question 29

What causes neurological changes with CKD?

Answer 29

increased nitrogenous waste, electrolyte imbalances, acidosis

Question 30

what do high uremic levels do?

Answer 30

axonal damage

Question 31

integumentary changes with CKD?

Answer 31

from dry skin, neuropathy and calc/phosh deposition pruritis occurs

Question 32

What is one of the most important risk factors in the progression of CKD?

Answer 32

proteinuria - high protein levels in urine

Question 33

Why would a patient need a renal biopsy?

Answer 33

to provide a definitive diagnosis

Question 34

What medication therapy is used to manage hyperkalemia?

Answer 34

sodium polystyrene sulfonate

Question 35

What does sodium polystyrene sulfonate do?

Answer 35

exchanges sodium for potassium

Question 36

What are common medications used to treat patients with CKD?

Answer 36

ACEIs, ARBs, thiazide diuretics

Question 37

What are phosphate binders?

Answer 37

used to bind to phosphate so it is excreted in the stool

Question 38

What is the risk in administering magnesium containing antacids?

Answer 38

used in moderation because magnesium dependent on kidney excretion

Question 39

Why do patients with CKD need vitamin D?

Answer 39

to prevent hypocalcemia from the inability of the GI tract to absorb calcium in the absence of vitamin D

Question 40

What are erythropoiesis-stimulating agents?

Answer 40

available for the treatment of anemia, stimulate the kidneys to produce more erythropoietin so that the bone marrow produces RBCs

Question 41

Who should not receive ESA's?

Answer 41

Patients with HTN because it produces more RBCs increasing blood

Question 42

Why do patients with CKD need iron?

Answer 42

increased demand for iron to support erythropoiesis, it uses iron stores

Question 43

Why do patients with CKD need folic acid?

Answer 43

it is needed for RBC formation and it removed by dialysis

Question 44

What medications require baseline kidney function assessment?

Answer 44

digoxin, oral glycemic agents, antibiotics, opioid medication because the dosage depends on the kidneys function, excretion etc.

Question 45

Why are protein restrictions sometimes necessary in patients with CKD?

Answer 45

BUN is an end product of protein metabolism

Question 46

Why are protein restrictions sometimes necessary in patients with CKD?

Answer 46

BUN is an end product of protein metabolism which has to be excreted by the kidneys and if the kidneys are not working it cannot be excreted

Question 47

23. Why are potassium restrictions sometimes necessary?

Answer 47

due to the ability of the kidneys to excrete this electrolyte

Question 48

What types of potassium rich foods should patients with CKD avoid?

Answer 48

oranges, bananas, melons, tomatoes, prunes, raisins, deep green/yellow veggies, beans, legumes

Question 49

What kinds of foods are high in phosphate

Answer 49

Dairy

Question 50

What are early signs/symptoms of CKD?

Answer 50

fatigue, lethargy, pruritus, HTN/changes in urine often first signs

Question 51

How can you assess for excess fluid volume

Answer 51

edema, urine changes