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What is CKD? What characterizes it?
A progressive loss of kidney function occurring over several months to years. Characterized by gradual replacement of normal kidney architecture with interstitial fibrosis.
CKD is also known as…?
Chronic renal insufficiency, progressive kidney disease, nephropathy
Kidney failure is defined as __ GFR.
<15
Name 3 major initation factors of CKD.
DM, HTN, Glomerulonephritis
Name 5 major progression factors of CKD.
Hyperglycemia, Hypertension, Proteinuria, Smoking, Obesity
Hyperglycemia, hypertension, and hyperlipidemia reduce ___ ___ to cause CKD.
Filtration area
What is normal GFR?
120
What need to be checked/found during a screening for CKD?
Scr > 1.2-1.5, GFR < 120, Protein in the urine, and ultrasound for structural damages
CKD is classified as damage greater than ___ months with or without decreased GFR
3
In early insufficiency, stage 2, what rises?
PTH
In stage 3, or moderate failure, where gfr is 30-59, what happens?
calcium absorption decreases, malnutrition, and anemia
In pre ESRD, 15-29, what happens?
TGs rise, acidosis, Hyperphosphatemia, and hyperkalemia,
In ESRD, which is <15 or pt is on dialysis, what happens?
Azotemia
What are the classifications of kidney function and their corresponding GFR?
1, damage: >90; 2, early insufficiency, 60-89; 3, moderate failure, 30-59; 4, pre esrd, 15-29; 5, esrd, <15 or dialysis
Structural kidney damage is indicated by macroalbuminemia which is where proteinuria is greater than ___ and microalbuminemia is where proteinuria is ______.
>300, 30-300
Normal protein in the urine should be <___. Normal albumin in the urine should be <__ in a 24 hour collection.
300, 30
ACR spot collection corrects for variation in hydration. What is normal ACR? Microalbuminuria? Macroalbuminuria?
<30, 30-299, >300
What are the symptoms found in stage 1 or 2?
Absent OR high PTH
What are the symptoms found in stage 3 or 4?
Minimal, edema, uremic symptoms such as cold intolerance, SOB, and fatigue, palpitations, cramps, muscle pain, depression, anxiety, sexual dysfunction
What are the symptoms found in stage 5?
More severe, pruritis, weight gain
T/F – You will see hypernatremia only in CRF.
F-both, hyponatremia may present too
T/F – Hypokalemia is a symptom of CRF.
F- Hyper, Potassium will go UP, not down.
What type of CV presentation will CRF have?
Edema, HTN, ECG changes, Hyperhomocysteinemia, Dyslipidemia
What type of Fluid electrolyte problems will there be? (Sodium, Potassium, Acid/Base?)
Hyper or HypoNatremia, Hyperkalemia, and Metabolic acidosis
GI presentation of CRF?
GERD, Weight Loss, Weight Gain
Endocrine presentation of CRF?
Secondary hyperparathyroidism, Decreased Vitamin D activation, Gout
Hemotologic presentation?
Anemia, Iron deficiency, Bleeding
What is the KDOQI recommendation for daily protein intake in CRF? What if patient is malnourished?
0.6g/kg/day, 0.8 if patient is malnourished
When is it appropriate to initate pharmacotherapy for hypertension and protenuria?
BP > 130/80, ACR >200
What is the #1 pharmacologic choice for CRF?
ACE Inhibitors
What is the goal BP primary blood pressure goal? Secondary goal for proteinuria?
<130/80, <125/75
Why is captopril not the best choice for ACE inhibitors?
Low compliance cause of multiple dosing during day
What is the suffix of ACE inhibitors?
-pril
What happens if the SCr increases greater than 30%?
stop, might caused ARF
If ACEs are given with potassium sparing diuretics, ARBs, or tekturna what can happen?
Hyperkalemia
ACE inhibitors are contraindicated in what 3 things?
BRAS, Pregnancy, Angioedema
What needs to be monitored when patients are on an ACE or ARB?
BP, CHEM-7 for SCr & K
What is good about ARBs?
Will decrease proteinuria by 25-47% but it’s a slow progression
What is the suffix of ARBs?
-sartan
If Cl<30, what should you do with an ARB or ACE?
Start monitoring
What did ONTARGET trial prove about ACE and ARB combinations?
Cause hyperkalemia and decreased clinical outcomes!!
Ca Channel Blockers are #3 choice, but provide a ________.
Renal protective effect to reduce the decline of kidney function
T/F – You may only give Dihydropyridines.
F – NON Dihydropyridines ONLY!!
Which ones are dihydropyridines?
Diltiazem and Verapamil
What are the main side effects seen with CCBs?
Bradycardia and constipation
T/F- Diuretics offer renal protective effects.
F- no evidence proves so
If you use a diuretic, which one? Should anything else be added? What and when?
High dose loop like furosemide, add thiazide when the GFR is > GREATER THAN > 30 only.
Diuretics are potassium _____.
Sparing
What should you monitor in diuretic use?
Volume, Potassium(K), Magnesium (mg)
Do not use tekturna when?
Pregnancy or angioedema
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