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CC July 2018 Chronic Kidney Disease (CKD)

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echoecho's version from 2018-09-03 17:20

Section

Question Answer
Define CKD?abnormal structure of function of kidneys that last at least 3 months
List the markers of CKD?1) albuminuria 2) abnormalities of urine sediment 3) abnormalities of kidney imaging 4) derangements of serum electrolytes or acid-base balance 5) GFR of < 60
List the stages of CKD?1) STAGE 1 (kidney damage with normal or increased GFR. Est GFR > 90) 2) STAGE 2 (kidney damage with mildly decreased GFR. Est GFR 60-89) 3) STAGE 3a (mildly to moderately decreased GFR. Est GFR 45-59) 4) STAGE 3b (moderately to severely decreased GFR. Est GFR 30-44) 5) STAGE 4 (severely decreased GFR. Est GFR 15-29) 6) STAGE 5 (kidney failure. Est GFR < 15 (or undergoing dialysis)
In what stages must there be markers of kidney disease, give the markers?1) albuminuria 2) persistent proteinuria
CKD affects about _____ million persons in the US and is assoc'd w/ significant morbidity, mortality and financial burden47
Why has the incidence of CKD stabilized?due to improved recognition and treatment of conditions (HTN, DM) that predispose to CKD
What two things can mitigate many of the complications associated with the condition?1) identification 2) treatment of CKD
Patients with HTN or DM should be screened _______ for CKD, even if the diseases are well controlled?annually
Consider screening of at-risk patients, list these?those with 1) CVD 2) hx of low birth weight 3) obesity 4) family hx of CKD
*** True or false? The USPSTF found insufficient evidence to assess the risks and benefits of screening asymptomatic adults routinely for CKD?true
Screening may include using what screening?1) estimation of GFR using a serum creatinine-based equation (standard on many routine chemistry panels) OR a 2) spot urine albumin/creatinine ratio.
Isolated albuminuria should be confirmed with what?1) first voided specimen after UTI (if present) has been treated 2) no vigorous exercise has been performed for 24 hours 3) menses is not present (if applicable)
Is 24 hour urine collections recommended for screening?no
Estimated GFR can be interpreted according to the _______?KDIGO guidelines
List the initial lab evaluation of patients wtih newly diagnosed CKD includes?1) serum electrolytes 2) fasting lipid panel 3) glycosylated hgb 4) UA w/ microscopic urinary sediment (if intrinsic renal disease is suspected), 5) CBC 6) renal US
When CKD is established, several co-existing onditions must be identified and addressed, list these?1) use of NSAIDs and nephrotoxic agents should be avoided or minimized 2) HTN control is essential while AVOIDING low BP levels that may decreased renal perfusion 3) Use of IV contrast radiographic agents should be minimized 4) Medication dosing must be continually adjusted based upon the patient's GFR
CARDIOVASCULAR DISEASE
CKD is associated w/ an increased risk of ______ disease, _____ death and all-cause mortality?cardiovascular; cardiovascular
The panel members appointed to the 8th Joint National Committee recommended a goal of < ____/____, whereas the KDIGO BP group endorsed a goal of < ____/____?140/90; 130/80
*** What 2 mediations are recommended for patients with albuminuria, but GFR and serum potassium levels must be closely monitored?1) ACEI 2) ARBs
*** There is evidence that early initiation of ACEI or ARB therapy can slow the disease progression and maintain renal function; treatment w/ one of these drugs is recommended for patients w/ HTN and Stage 1-3 CKD, true or false?true
Thiazide diuretics are generally ineffective when the GFR is < _____ and initiation of _____ diuretcs becomes necessary at that stage?30; loop
Statins should be for patients with an elevated ____ year risk of cardiovascular, which includes many CKD patients?10
Should antiplatelet agents be prescribed in patients with CKD?yes
Dosing of common therapies for heart failure may need to be adjusted for patients with _____ CKD?advanced
Why is smoking cessation is strongly encouraged?several studies indicate that smoking is associated with progresion of CKD as well as being a cause of CVD
ANEMIA
Why are patients with advanced CKD also at increased risk of developing anemia?due to impaired renal production of erythropoietin and abnormal utilization of existing iron stores
Once CKD stage 3 is diagnosed, what annual testing should be done?anemia (CBC, reticulocyte count, iron, ferritin, transferrin)
Is measurement of serum erythropoietin levels clinically useful?no
Several trials have evaluated the benefits of raising hemoglobin levels to "higher normal" levels (13-14) compared to "lower normal" levels (9-10) in patients with CKD. Was there any significant difference between the two groups?No, however, patients radnomized to the higher hgb level had a higher incidence of access-site thrombosis, stroke and, possibly, cardiovascular events. It is unclear if this was due to the higher dose of erythropoietin prescribe or because the underlying renal diseaes was more severe.
*** What are the KDIGO guidelines regarding when erythropoietin should be initated?Erythropoietin should NOT be initiated until the hgb level is , 10, with a target level of not higher than 11.5
If no increase in hgb is noted after 1 month of erythropoietin treatment, the dose an be increased as much as ____% beyond the calculated weight-based dose?50
MINERAL AND BONE DISORDERS
In advanced CKD (stage 3 and above), there is an increased incidence of metabolic _____ and ______ disorders?bone; mineral
Screening is recommended with what labs?calcium, phosphorus, 25-hydroxy vit D, 1,25 dihydroxy-vitamin D, parathyroid hormone and alkaline phosphatase
Consultation with nephrologist is also recommended in what situations?1) anemia of CKD (hgb < 10) 2) family hx of CKD 3) presence of red blood cell casts in the urine 4) rapid progression of CKD 5) refractory HTN 6) persistently abnormal serum potassium 7) refractory severe albuminuria or proteinuria 80 GFR < 30
*** SUMMARY = The family physician has an ooportunity to help prevent CKD with early diagnosis and appropriate therapy for what 2 diseases?HTN; DM
*** SUMMARY = Early initiation of what 2 medications can slow disease progression and maintain renal function?ACEI, ARB
*** SUMMARY = True or false? Avoidance of neprhotoxic agents and adjustiment of medication dosing are essential elements of CKD management?true
*** SUMMARY = Patients w/ CKD, especially in ________ stages, should be co-managed with nephrologist?advanced
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