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Renal 24 CKD
Thomas: Clinical Manifestations of Chronic Kidney Disease
| Question | Answer |
|---|---|
| Chronic Kidney Disease (CKD) Definitions | GFR <60 for >3months or Structural/functional abnormalities of the kidney |
| What percent of the US population is affected? | >10% (>20 million) |
| What increases incidence? | Age Diabetes Increased longevity |
| End-stage renal disease (ESRD) defined as... | GFR <15% Usually required dialysis |
| How many people have ESRD, and what is the 5 year survival rate? | >500,000 people in 2008 5 year survival rateL 34.5% |
| CKD Risk factors | Diabetes Mellitus HTN Obesity/metabolic syndrome CV disease Smoking Glomerular diseases |
| If you're looking for CKD, what labs would you order and why? | BMP for creatintine/GFR UA for protein,hematuria,casts UA for microabluminuria Recommended yearly for pts with diabetes or HTN |
| CKD Clinical Manifestations | CV disease Anemia Bone disease Increased infxn rate |
| Pts with CKD are more likely to die from ___ before they progress to ESRD | CV disease |
| A 10mL/min decrease in GFR | Mortality increases by 7% |
| As GFR decreases, so does... | Vascular compliance |
| CKD and CV disease Treatment | Lifestyle Modification -Exercise, low salt fat diet Aggressive BP control (<130/80) -ACEI/ARBs LDL<100 Glycemic Control |
| CKD and Anemia | Seen in stage 4-5 ↓ erythropoietin production |
| What can anemia cause in pts with CKD? | Chronic hypoxemia -↑ free radicals -MI/angina due to supply/demand mismatch -Activation of RAAS → LVH |
| Signs and symptoms of anemia | Tired SoB Palor Cyanosis Fatigue |
| CKD and anemia Treatment | Erythropoietin stimulation agents -use when Hb <10 g/dL Target level 11-12 g/dL |
| Things to do before starting erythropoietin-stimulating agent | 1. Rule out other causes of anemia -B12 deficiency, GI bleed, hemolysis 2. Check for adequate iron stores -Ferritin should be >100 |
| CKD and Bone Disease | ↓ phosphorus clearance ↓ conversion of Vit D2 to D3 ↑ PTH release and parathyroid hyperplasia ↑ Bone Destruction |
| What conditions usually stimulate PTH release? | ↑ serum phosphorua ↓ serum Ca |
| CKD and Bone Disease Manifestations | Suberiostial bone resorption (fingers and clavicles) "Brown" tumors→erosive osteolytic lesions -taking away bone, leaving holes |
| CKD and Infections Mechanism and Treatment | M: decreased B/T cells and macrophage function due to uremic toxins Tx: Prevention=Vaccinate Hep B, Influ, Strep pneumo |
Created by:
bcriss
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