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Details

CKD Stages 1 and 2
Dr. Cardone
17
Pharmacology
Graduate
01/29/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
What do Stages 1 and 2 of CKD represent?
Definition

1.  Kidney Damage with normal or increased GFR

2.  Mild Decrease GFR

Term
What are the risk factors and consequences of CKD?
Definition

 

 

 

 

Susceptibility

Inc. age, low birth weight, small kidneys, racial minority,

FH, low income, low education, systemic inflammation,

dyslipidemia

 

 

 

Initiation

DM, HTN, GN

 

 

 

Progression

Glycemia, HTN, proteinuria, smoking, obesity

Consequences

Associatead with high prevalence of CVD, HTN, Anemia, increased mortality

Term
What are the action plans at each of the five stages of CKD?
Definition

@ Risk - Screening, CKD risk reduction

1 - Diagnose/Tx of CKD, Tx comorbid conditions, slow progression, Dec. CVD risk

2 - Estimate progression

3 - Evaluate and Tx complications

4 - Prepare for KRT

5 - Provide KRT

Term
What is DKD and what are its complications?
Definition

DKD - Diabetic Kidney Disease

- Vascular changes in the kidney

- Proteinuria and declining GFR

- Patients may also have DM + another cause of CKD

- If the patient HAS DM, they are at a higher risk for progression of CKD

Term
How do we screen for DKD?
Definition

- Urinary Albumin excretion

- Serum Creatinine

- Screen annually, and if diagnosed with T1DM screen 5 years after diagnosis, and with T2DM screen AT diagnosis

Term
In terms of microvascular complications, stroke, death, and any DM endpoint, which is more effective: Tight blood glucose control or tight blood pressure control
Definition
- In various studies, tight blood glucose control shows a statistically significant decrease in complications of DM/HTN patients. 
Term
What is the difference between micro- and macroalbuminuria? 
Definition

Micro - occurs when the kidney leaks small amounts of albumin into the urine, in other words, when there is an abnormally high permeability for albumin in the renal glomerulus.

Macro - Microalbuminuria is diagnosed either from a 24-hour urine collection (20 to 200 µg/min) or, more commonly, from elevated concentrations (30 to 300 mg/L) on at least two occasions.[1]. An albumin level above these values is called "macroalbuminuria", or sometimes just albuminuria.

Term
For a 24h and spot albumin creatinine collection, what levels represent microalbuminuria?
Definition

30-300

 

Any higher in the 24h collection is Albuminuria

Term
For a 24h and spot albumin creatinine collection, what levels represent Proteinuria?
Definition

24h - >300

Spot - >200

Term
What are the treatments for micro/macroalbuminuria?
Definition

 

 

 

 

 

 

 

 

 

 

 

T1DM

 

+ HTN + micro/macro-              ACEi

albuminuria

 

 

 

 

 

T2DM + HTN + microalbuminuria                              ACEi or ARB

T2DM

 

+ HTN +

macroalbuminuria +                          ARB

SCr>1.5mg/dl

                       

Term
What is glomerulonephritis?
Definition

- Blanket term to describe many diseases

- S/S generally classified into Nephritic/Nephrotic

Term
What is the difference between nephritic and nephrotic symptoms?
Definition

Nephritic - "ITIS" means inflammation

- Hematuria

- Proteinuria

 

Nephrotic - Proteinuria (>3.5g/day), edema, hyperlipidemia, hypercoagulable state

Term
What does Urinalysis and bloodwork yeild if a patient has Nephritic syndrome?
Definition

Urinalysis - Proteinuria (>3g/day), Cellular casts, Granular casts

 

Bloodwork - GFR decline if glomerular surface is reduced, hypoproteinemia, hypercoagulabe state (some patients)

Term
What are therapeutic options in non-DM CKD?
Definition

- Corticosteroids

- Cyclophosphamide

- Cyclosporine

- Mycophenolate

Term
What are our roles as pharmacists in the treatment of CKD?
Definition

 

 

 

- Identify those with or at risk for CKD

 

 

 

- Recommend screening (i.e. PCP, KEEP)

- Educate the patient / increase awareness of CKD

 

 

 

- Identify appropriate progression-modifying

- interventions

 

 

 

- Reconcile medication lists

 

 

 

- Optimize medication use

 

 

 

Patient-focused (adherence)

Provider-focused

Term
How do we identify patients with CKD?
Definition

 

 

 

Medications for initiation factors

(i.e. DM/HTN)

 

 

 

Rx from a nephrologists

 

 

 

Dose adjusted medications in the Rx profile

 

 

 

Receipt of CKD-specific medications

(i.e. phosphate binders, calcimimetic agent, active Vit

D, etc)

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