CKD 1

Question 1

Duration of CKD?***

Answer 1

3 months

Question 2

The combination of CKD and ____ significantly raise the risk of CVD and death.

Answer 2

diabetes

Question 3

What treatment of patients with ESRD/CKD is a major cause of morbidity and mortality?

Answer 3

dialysis

Question 4

What is a common cause of death in pts w/ ESRD?

Answer 4

Cardiovascular Disease

Question 5

What is the life expectancy of age group 40-44 y/o w/ ESRD?

Answer 5

8 years

Question 6

Which 2 conditions are the major causes of CKD?

Answer 6

DM & HTN

Question 7

Kidney disease for greater than _____ as evidenced by structural or functional abnormalities with or without decreased GFR.

Answer 7

3 months

Question 8

CKD is the presence of GFR < ___ for ___ months with or without other signs of kidney damage.

Answer 8

60

3 months

Question 9

1 abnormality of CKD?

Answer 9

Albuminuria

Question 10

**Stage 5 CKD is a GFR < ___ and the patient is on dialysis (ESRD)***

ON EXAM

Answer 10

<15

Question 11

In which stage of Albuminuria should you intervene early to slow progression of CKD?

Answer 11

A2 & A3

(moderately & severely increased)

(3 mg/mmol or more)

Question 12

What medication is shown to decrease progression in early stages?

Answer 12

ACE inhibitors

Question 13

What measurement is now included w/ GFR measurements?

Answer 13

Albuminuria

Question 14

• Pts w/ CKD are usually asymptomatic until GFR is < ___.
• What sxs would they have?

Answer 14

• 15
• Mental foginess, N/V

Question 15

In which 5 people would you screen for CKD?

Answer 15

• • fam hx
• HTN
• DM
• >60 y/o
• Ethnic minorities (Northern Africa, Latin America, Native Americans)

Question 16

3 complications of CKD

Answer 16

• Anemia
• Coagulopathy
• Pericarditis

Question 17

uPRO/uCR ratio correlates to the expected grams of ____ in ___ hours.

Answer 17

protein / 24 hrs

Question 18

4 components of a UA/ urine microscopy

Answer 18

• Sediment analysis
• RBCs / RBC casts (nephritic)
• WBCs / WBC casts (infection)
• Crystals for stones

Question 19

What test is NOT usually helpful for evaluation of CKD?

Answer 19

24 hour urine

Question 20

Eval/Labs of CKD

• _____ is not affected by meds that affect the renal tubules

Answer 20

Cystatin C

Question 21

• What 3 labs will you order once disease has been determined?
• What are 2 other things to look for?

Answer 21

• Electrolytes (Na, K, Ca, Phos)
• CBC
• BUN
• Hyperparathyroidism evaluation
• Serum Protein Electrophoresis (SPEP)

Question 22

US eval

• _____ suggestive of chronic disease
• ____ from obstruction
• ____ and infiltrative cancers can cause enlargement
• Disparity from _____

Answer 22

• Atrophic kidneys
• Hydronephrosis
• Amyloidosis
• ischemia

Question 23

The National Kidney Foundation recommends that every pt w/ GFR < ___ (stages __ & __), undergo a nephrology evaluation.

Answer 23

60 / 3 & 4

Question 24

What is the first step in treating CKD?

Answer 24

Prevention

• Control hyperglycemia
• Meet ACC/AHA guidelines for HTN (but don’t tx too aggressively)
• Review meds

Question 25

What is the BP goal for pts w/ CKD?

Answer 25

140/80

Question 26

3 causes of Pre-renal

Answer 26

* Hypotension * Hypovolemia * Medications

Question 27

3 causes of Intrarenal

Answer 27

* Meds (Vanco, Aminoglycosides, NSAIDS) * IV contrast * Infection

Question 28

Cause of post-renal

Answer 28

Obstruction

Question 29

4 meds which can cause a false + rise in creatinine (Interfere w/ creatinine secretion and assay)

Answer 29

* Cimetidine * Trimethoprim * Cefoxitin * Flucytosine

Question 30

Progression often due to what 3 causes unrelated to the original disease (cause scarring and further decline in kidney function)

Answer 30

* Intra-glomerular HTN & hypertrophy * Metabolic acidosis * Tubulointersitial disease ## Footnote **(TIM)**

Question 31

**Slowing Progression of CKD** * HTN management * DM management * Smoking cessation * Tx cholesterol * Renal vitamins (which 4?) * What type of diet?

Answer 31

* K, Ca, P, Mg * Low protein diet and water

Question 32

* ACE inhibitors or ARBs have greatest benefit when GFR is what value? * With or without proteinuria?

Answer 32

\>60 (early on in disease)

Question 33

* Can usually maintain fluid balance until GFR is \_\_. * What is a good way to manage volume?

Answer 33

* 15 mL/min * Na reduction

Question 34

In which 2 circumstances would you monitor potassium in pt?

Answer 34

* Pts w/ oliguria * Pts on K sparing meds

Question 35

**Which condition?** * May play a rose in further disease progression * Can worsen bone disease * Can worsen cachexia * Sodium Bicarbonate for tx

Answer 35

Metabolic Acidosis

Question 36

**Disorder in mineral metabolism** * Hyperphosphatemia * Hypocalcemia * Low vit D --\> results in?

Answer 36

Secondary hyperparathyroidism

Question 37

**Tx Complications of CKD** * Mechanism differs based on degree of CKD * If untreated, secondary hyperparathyroidism & renal osteodystrophy occur * Dietary modifications important in early disease * Phosphate binders required once GFR is \<\_\_.

Answer 37

Hyperphosphatemia * 25

Question 38

As GFR decreases, what happens to Phosphorus and Calcium?

Answer 38

* Phosphorus increases * Calcium decreases

Question 39

**Tx Complications of CKD** * Common problem in CKD * Several manifestations * Vit D deficiency * KDOQI and KDIGO guidelines

Answer 39

Bone Disease

Question 40

**Tx Complications of CKD** * Typically _____ \_\_\_\_\_\_ * Usually when GFR \<\_\_ * Usually from reduction in erythropoietin (can give erythropoietin prior to dialysis) * Non-renal causes need to be evaluated

Answer 40

* Normocytic normochromic * 60

Question 41

**Tx Complications of CKD** * ___ usually develops w/ GFR \<\_\_\_ * Sxs: * N/V * Anorexia * Fatigue * Confusion * Platelet dysfunction * Pericarditis * Neuropathy * Sexual dysfunction

Answer 41

Uremia

Question 42

**Values of GFR** * Severely decreased (prep for transplant) * Kidney failure (transplant)

Answer 42

* 15-29 * \<15

Question 43

**Definition:** * Diffusion of small molecules down their concentration gradient across a semi-permeable membrane

Answer 43

Dialysis

Question 44

5 Indications for EMERGENT dialysis

Answer 44

* **Acidosis** (Severe Metabolic Acidosis) * **Electrolyte disturbance** (Severe hyperkalemia) * **Intoxication** (Overdose w/ dialyzable substance) * **Overload** (fluid overload unresponsive to diuretic therapy) * **Uremia** (BUN \>100) ## Footnote **AEIOU**

Question 45

5 indications for NON-emergent dialysis

Answer 45

* **HTN** (medication resistant) * **Uremia** * **Metabolic disturbance** (chronic acidosis, hyperkalemia) * **N/V - malnutrition** * **Fluid overload** (diuretic resistant) (HUMNF)

Question 46

**Definition** * Retention of nitrogen waste from kidney dysfunction * Pericarditis * Neurologic (Seizures, encephalopathy, Asterixis) * Coagulopathy

Answer 46

Uremia * Asterixis: tremor, jerking of hand, tongue and feet

Question 47

4 factors of diffusion of dialysis

Answer 47

* Blood flow rate * Membrane surface area * Permeability of membrane * Time

Question 48

**Definition:** Removal of water from patients circulation

Answer 48

Ultrafiltration

Question 49

What are the 3 types of Dialysis?

Answer 49

* Standard dialysis (hemodialysis) * Peritoneal dialysis * Continuous renal replacement therapy (CRRT)

Question 50

5 complications of Standard Dialysis

Answer 50

* Hypotension * Disequilibrium syndrome (HA, lethargy, nausea) * Dialyzer reactions (Type A - anaphylaxis) * Clotting / bleeding * Arrhythmias

Question 51

**What type of dialysis?** * Dialysate solution is introduced via catheter * Uremic toxins diffuse across capillaries * Water moves toward the hypertonic dialysate fluid following osmotic gradient * The "dirty" fluid is drained

Answer 51

**Peritoneal Dialysis** * Catheter is placed in peritoneal cavity * Uremic toxins diffuse across peritoneal capillaries across the peritoneal membrane into the peritoneum

Question 52

* What are the 3 complications of Peritoneal Dialysis? * Which one is the major complication?\*\* (probably on exam)

Answer 52

* **PERITONITIS!!** (most important) * Exit site infection * Poor dialysate drainage

Question 53

**Renal Transplantation** * Best option for renal replacement therapy (if no contraindications) * Mortality if 2.6X greater on dialysis * Mortality reduced by 68% * Wait list is growing * Median wait time?

Answer 53

2.6 years