Term
| What are markers of kidney damage? |
|
Definition
- Persistent proteinuria
- Abnormalities in blood or urine
- Decreased GFR/CrCl |
|
|
Term
| What are the stages of CKD? |
|
Definition
Stage 1 - >/ 90
Stage 2 - 60-90
Stage 3 - 30 - 59
Stage 4 - 15 - 29
Stage 5 - Kidney failure, <15 or dialysis |
|
|
Term
What are initiation factors of CKD?
Progression factors? |
|
Definition
- DM2, HTN, autoimmune diseases
- above, and smoking, protein in urine, lipids, drug use
Ace-I and ARBs reduce proteinuria - presence of albumin or globulin |
|
|
Term
| What patients are at risk for CKD? |
|
Definition
| Diabetes, hypertension, family history of CKD, > 60 years, belong to U.S. racial or ethnic minority |
|
|
Term
| What are types of proteinuria? |
|
Definition
- Normal - < 30
- Microalbuminuria - 30 to 300 mg/day
- Macroalbuminuria - >/300 mg/day |
|
|
Term
| What are symptoms of CKD, especially in later stages? |
|
Definition
Edema/cold intolerance, SoB, cramping, depression, itching, weight gain
Uremia causes itching and loss of appetite, mental confusion
As condition worsens in Stage 3, iron deficiency and anemia, electrolyte disorders, Vit D can't activate |
|
|
Term
|
Definition
- Slow progress by:
- Decreasing protein intake, insulin therapy and Ace-I reduce albuminuria
- HTN goal <130/80 - AceI + aldosterone inhibitor |
|
|
Term
| How is HTN treated in CKD? |
|
Definition
1st line - AceI/ARB
- Then use non-DHP CCBs in patients w/o HF
- Give diuretic, thiazides don't workin in patients w/ GFR < 30 |
|
|
Term
| What are other goals in CKD? |
|
Definition
- LDL goal < 100 per K/DOQI guidelines, need statin
- QUIT SMOKING!
- Treat anemia |
|
|
Term
| What main electrolyte abnormalities are seen in CKD? |
|
Definition
- Lose ability to excrete Na after CrCl < 20 (stage 4 and 5) - increased volume overload
- 90% potassium excreted by kidneys |
|
|
Term
| How is Hyperkalemia managed in CKD? |
|
Definition
- Calcium gluconate when symptomatic, then excrete or push K back into cells w/ insulin, albuterol, an kayexelate
- Can use lasix, but not in stage 5 |
|
|
Term
| What causes metabolic acidosis in CKD, and how is it treated? |
|
Definition
Increased uremia, have to draw ABG often
Try to keep pH normal and bicarb between 22-26.
Correct w/ sodium bicarbonate, sometimes chronically |
|
|
Term
| How is secondary hyperparathyroidism recognized in CKD and what are it's implications? |
|
Definition
| A high phosphate level (over ) inhibits Vitamin D --> lowers calcium. When calcium is low, PTH tries to correct and increases abnormally --> low Ca, high PTH, high phos, Ca*Phos > 55 |
|
|
Term
| What are treatments for high phosphate in sHPT? |
|
Definition
- Restrict dietary phosphorus
- Calcium based phosphate binders if normal calcium level - Phoslo
- In STAGE 5 - non-calcium phosphate binder, use in presence of incr calcium - Sevelamer, Lathanum, aluminum last line |
|
|
Term
| How do you evaluate Vit D deficiency? |
|
Definition
Use Vit D when PTH level high AND Ca/Phos normal.
Use Vit D if < 30 - Ergocalciferol
Give active vit D if PTH very high (300) - may cause incr Calcium
D/C all forms if Ca > 10.2, if Phos uncontrolled |
|
|
Term
| When should Sensipar be used? |
|
Definition
Calcimimetic, only used in stage 5
Used in patients not eligible for Vit D due to a high calcium, last line
Take with food, GI effects, lowers calcium |
|
|
Term
| What is the cause of anemia in CKD? |
|
Definition
RBC life span decreased, EPO excreted. Anemia panel assesses, Hgb < 12 in women, 13.5 in men
Goal TSAT > 20%, ferritin > 100
treat w/ iron supplements w/ Vit C
Use EPO after anemia causes treated, cannot give w/ uncontrolled BP, give when HGb < 10, target Hgb 11 |
|
|
Term
| What are CV goals associated w/ CKD? |
|
Definition
HTN - BP goal < 130/30
LDL < 100 per KDOQI |
|
|
Term
| What are other possible complications of CKD? |
|
Definition
- Pruritus due to uremia and toxins
- Malnutrition, loss of water soluble vitamin, uremic bleeding |
|
|
Term
| What are normal electrolyte values associated with CKD? |
|
Definition
K: 3.5 - 5.0
Na: 135 - 145
Mg: 1.5 - 2.5
Phos: 2.5 - 4.5
Ca: 8.5 - 10.5 |
|
|
Term
| When is dialysis indicated? |
|
Definition
Planning begins in stage 4
Assessed via clinical status
Usually RRT - Toxins move into dialysis fluid and are excreted via diffusion |
|
|
Term
| How is hemodialysis access managed? |
|
Definition
- AV fistula - anastomosis between cephalic vein an radial artery - takes time to mature thus planning in stage 4. Lowest rate of infection
- AV graft - much higher infection, lower shelf life
- Venous catheter - highest risk |
|
|
Term
| What are complications that can result from dialysis? |
|
Definition
- Intradialytic - hypotension, cramps, uremia, HA, pain, infection
- Thrombosis - common in venous catheter. Lock access port & flush with saline
- Infection - MRSA |
|
|
Term
What is peritoneal dialysis better than HD?
How does it work? |
|
Definition
Less infection, preserves renal function longer, less visits
Travels by diffusion across membrane, sits in the kidneys, then drains
- Catheter can kink, pain at site, infection |
|
|
Term
| How does HD effect drug dosing? |
|
Definition
if the drug has a large size, is protein bound, or a high Vd --> decreased removal
Dose of meds depends on filter |
|
|
