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Senior - GU Test 1 > 12 - CKD > Flashcards

12 - CKD Flashcards

1
Q

National kidney foundation (NKF) defines CKD as?

A 
Evidence of renal damage based on:
- abnormal UA (protein, heme)
Or
- structural abnormality by US
Or
- GFR <60 mL/min

For >3 months

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2
Q

Stages of CKD?

A

1: GFR >90
- damage
2: GFR 60-89
- mild
3: GFR 45-59
- mild - moderate
4: GFR30-44
- moderate - severe
5: GFR < 15
- ESRD

Chart on slide 8

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3
Q

KDIGO guidelines

CKD definition?

A

Abnormalities of kidney structure of function persistent > 3 months

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4
Q

KDIGO guidelines CKD classification?

A

Based on GFR and albuminuria

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5
Q

MC risk factors for CKD?

A 
DM
HTN
Vascular disease
FHx of CKD
>60yo
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6
Q

Maj outcomes of CKD?

A 
CVD
Complications of Impaired renal function
- anemia
- DO of mineral metabolism
- 2ndary hyperparathyroidism
ESRD
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7
Q

Major causes of CKD?

A 
Primary glomerular diseases
Secondary glomerular diseases
Tubulointerstitial nephritis
Cystic disease
Obstructive nephropathies
Vascular disease

Examples on slid 12

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8
Q

Pathophys of CKD?

A

L clearance of certain solutes principally excreted by the kidney results in their retention in body fluids

Reduction in renal mass (nephron destruction)

  • hypertrophy of remaining nephrons
  • hyper-filtration
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9
Q

Symptoms of CKD?

A

Develop slowly and are nonspecific

Early stages - asymptomatic

Symptomatic once GFR <5-10

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10
Q

CKD physical findings

A 
Chronically ill-appearing
HTN
Dermatologic manifestations
Uremic fetor 
Mental status changes
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11
Q

What are mee’s lines?

A

Seen with the dermatologic manifestions of CKD

They are finger nail changes

Pic on slide 19

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12
Q

What is uremic fetor?

A

Urinous breath

Halitosis

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13
Q

UA findings for CKD?

A

Broad, waxy casts (stasis)
Persistent proteinuria
- persistent proteinuria - (CKD no matter the GFR)

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14
Q

CKD serum findings?

A 
H BUN/Cr (persistent)
L GFR (<60)
Anemia
Metabolic acidosis
Hyperphosphatemia
Hyperkalemia
Hypocalcemia
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15
Q

Caution when using serum creatinine to track CKD because?

A

Serum creatinine may remain normal until there has been a severe decline in GFR

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16
Q

imaging with CKD?

A

US - small (<9-10cm)

Radiology - evidence of renal ostedostrophy

  • phalanges of hands
  • clavicles
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17
Q

Complications of uremia

A
  • Cardiovascualr - (50% of deaths in pts w ESRD)
  • Disorders of mineral metabolism
  • Hematologic
  • Hyperkalemia
  • Acid-base disorders (metabolic acidosis)
  • Neurologic
  • Endocrine disorders
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18
Q

CKD cardiovascular complications?

A

HTN
CHF
Uremic pericarditis

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19
Q

MC CKD complication?

A

HTN

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20
Q

Lifestyle changes for HTN pts?

A

Decrease salt (2g/day)
Diuretic - Thiazide/loop
ACEI/ARB

Goal BP <140/90 mmHg

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21
Q

CKD and CHF?

A

A chain of events

CKD causes HTN (RAAS stimulation), volume overload, anemia

  • Lead to higher cardiac workload
  • accelerated atherosclerosis

contributes to LVH and HF

22
Q

uremic pericarditis presentation?

A

S/s - pleuritic chest pain/fever
PE - pulsus paradoxus and friction rub
ECG - low voltage, electrical alternans
CXR - enlarged cardiac silhouette

23
Q

Pericarditis is?

A

An absolute indication for hemodialysis and hospitalization

24
Q 
CKD pts (esp those w DM) will likely die from
?
A

CVD is much more likely than ESRD

CKD - look at heart
Heart disease - look at kidney

25
Q

Low GFR and small kidneys have what effect on mineral metabolism?

A

Osteitis fiberosa cystica (H PTH)
Adynamic bone disease (L PTH)
Osteomalacia (L vit D)

26
Q

MC mineral disorder from CKD?

A

Osteitis fibrosa cystica

- secondary hyperparathyrodism -> osteoclast stimulating effects of PTH

27
Q

Why does CKD lead to bone problems?

A

Hserum phosphorus (hyperphosphatemia

L vitamin D -> (hypercalcemia)

H PTH (secondary hyperparathyrodism) -> Renal osteodystrophy (bone disease)

28
Q

Tx for mineral metabolism do?

A

Hyperphosphatemia control

  • phosphorus restriciton
  • phosphorus binding agents

Hyperparathyrodism tx

  • vit D
  • Calcitriol
29
Q

Hematologic complications of CKD?

A

Anemia - normochromic, normocytic

  • low erothropoietin
  • low iron absorption

Coagulopathy

  • platelet dysfunction
  • > petechia/purpura
  • > bleeding
30
Q

Dialysis effect on bleeding?

A

Improves bleeding time but doesnt normalize it

31
Q

CKD and hyperkalemia?

A

Potassium balance remains intact until GFR < 10-20ml/Min (CKD stages 4-5)

32
Q

Acute hyperkalemia needs?

A
  • Cardiac monitoring
  • IV calcium chloride or gluconate
  • Insulin w glucose
  • Bicarbonate
  • Sodium polystyrene sulfonate
33
Q

Chronic Hyperkalemia needs?

A
  • Dietary potassium restriction

- Sodium polystyrene PRN

34
Q

Damaged kidneys lead to what acid-base do?

A

Inadequate acid (H+) excretion -> metabolic acidosis

35
Q

Acid-base d/o tx?

A

Maintain/normalize serium bicarb level: >21 mEq/L
- alkali suppliments

Keep pH >7.20

36
Q

Neurologic complications?

A

Uremic encephalopathy - GFR <5-10

Peripheral neuropathies

37
Q

Endocrine complications of CKD?

A

H insulin (hypoglycemia)

L libido and ED (common)

38
Q

CKD management

A 
Tx underlying cause 
- esp DM
Meds
- ACEI/ARB, statin, diuretics
Consult
- CKD clinics (goal - stay off dialysis)
Pt eduction
- smoking 
Diet restrictions
- protein
- salt/water
- k+
- phosphorous
39
Q

CKD pts need to be evaluated by?

A

Nutritionist

40
Q

Once CKD -> ESRD pts need?

A

RRT - renal replacement therapy

  • hemodialysis
  • peritoneal dialysis
  • kidney transplant
41
Q

Indications for RRT?

A 
GFR <5-10
Uremic symptoms (pericarditis, coagulatpathy etc)
Fluid overload
Refractory hyperkalemia >7
Severe metabolic acidosis (pH <7.2)
Neurologic symptoms
BUN >100
42
Q

Problems w hemodialysis?

A

Vascular access complications
- infection, thrombosis, aneurysim

3 sessions/wk - 3-5 hrs each (15hrs/wk)

43
Q

What is peritoneal dialysis?

A

Peritoneal dialysis is a type of dialysis that uses the peritoneum in a person’s abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood.

44
Q

types of peritoneal dialysis?

A

CAPD - continuous ambulatory peritoneal dialysis

  • MC type
  • pt swaps bags out throughout the day

CCPD - continusous cyclic peritoneal dialysis
- machine works at night

45
Q

Which type of kidney transplant is best?

A

Living donor is much better

1 yr survival

  • 95% living donor
  • 89% deceased

5 yr

  • 80% living donor
  • 66% deceased
46
Q

Life expectancy for dialysis pts?

A

5 yr survival?
- 40%

Average life expectancy 3-5 yrs (though sometimes up to 25 yrs)

47
Q

Causes of death for CKD pts?

A

Cardiac disease (50%)
Infection
Cerebrovascular disease
Malignancy

48
Q

Bottom line for CKD pts?

A

Medical care is based on delaying/halting CKD progression

49
Q

With CKD pts always?

A

Be cognizant of necessary dose adjustments when prescribing meds

50
Q

Dont worry

A

Urine good hands

Senior - GU Test 1 (13 decks)

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