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DU PA Chronic K Dz
Duke PA Chronic Kidney Disease
| Question | Answer |
|---|---|
| progressive and irreversible loss of kidney function | chronic kidney disease |
| two most common causes of chronic kidney disease | diabetes, hypertension |
| in the united states approximately ___ million people have chronic kidney disease | 20 |
| the most specific tool to reach a difinitive diagnosis of chronic kidney disease | biopsy |
| interventions that reduce intraglomerular pressure such as ___, help attenuate progression of renal disease | ACEIs, ARBs, protein restriction |
| aggressive management of ___ attenuates the rate of progression of renal failure | hypertension |
| the target BP is <__ in patients with hypertension and diabetes or kidney disease | 130/80 |
| meds that block the production or effect of angiotensin II have a ____ | nephroprotective effect |
| recent research has shown that dietary restriction of ___ tends to slow the rate of progression of renal insufficiency | protein |
| the recommended dietary intake for a patient with chronic kidney disease is ___g/kg/day | 0.6 |
| ___ should be restricted, especially in patients who are hypertensive and edematous | sodium |
| in hospitalized patients ___ are on of the most common nephrotoxic drugs | aminoglycosides |
| by inhibiting vasodilatory ____ COX-2 inhibitors can decrease GFR, as well as cause acute interstitial nephritis | prostaglandins |
| ___ agents can cause acute or acute-on-chronic renal failure in hospitalization patients | radiocontrast |
| patients at high risk for contrast induced acute renal failure should receive | intravenous fluids with 50mEq bicarbonate 8-10 hours before and after the procedure |
| patients with renal failure usually become symptomatic when the GFR is <__mL/min | 10 |
| ___ can cause symptoms of fatigue, N/V, and headaches | urea |
| mortality from cardiovascular disease in patients with renal failure is __ times that of age matched population | 3.5 |
| Heart disease accounts for morht than __% of the deaths in patients with uremia | 50 |
| ___ contribute to LVH and CHF | anemia and hypertension |
| ___ can occur in patients with uremia | pericarditis |
| patients with renal failure usually describe ___ and loss of appetite | metallic taste |
| lethargy, irritability, frank encephalopathy, asterixis, and seizure are late manifestations of ___ an are usually avoided by early dialysis | uremia |
| peripheral neuropathy manifest in a | glove and stocking distribution |
| peripheral motor impairment can result in | restless legs, foot drop, or wrist drop |
| peripheral neuropathy can result in | decreased distal tendon reflexes and loss of vibratory perception |
| over time adaptive parathyroid hypertrophy becomes maladaptive and leads to | bone disease and tissue calcification |
| ___ becomes progressively deficient as renal function declines | erythropoietin |
| ___ are common causes of anemia in chronic kidney disease patients | erytropoietin and iron deficiency |
| chronic kidney disese patients are generally | immunosuppressed and are susceptible to infection |
| as renal function diminishes, many patients with diabetes will have | decreased insulin requirment, which can lead to hypoglycemic episodes |
| ___ is a common complaint of patients in renal failure | pruritis |
| abnormality present for more than 3 months | chronic |
| abnormal marker of kidney damage (proteinuria), diminished kidney function (GFR <60) | kidney disease |
| CRF, and CRI | outdated terms for Chronic Kidney Disease (CKD) |
| four most common causes of CKD in order of greatest to least | Diabetes, hypertension, glomerulonephritis, cystic kidney disease |
| inability to excrete sodium and water leads to | fluid accumulation, hypertension, edema |
| inability to excrete potassium leads to | cell membrane potential disorders |
| inability to excrete calcium and phosphorus leads to | bone metabolism, cell membrane instability |
| inability to of kidneys to control acid/base leads to | disfunction of cells and enzymes |
| cardiovascular disorders caused by uremia | Arrhythmias, accelerated atherosclerosis, cardiomyopathy |
| gastrointestinal disorders caused by uremia | Nausea, anorexia, dysgusia |
| neurological disorders caused by uremia | insomnia, seizures, coma |
| hematological disorders caused by uremia | bleeding, immune dysfunction |
| dermatological disfunction caused by uremia | pruritis |
| kidney failure leads to decreased vitamin D production which leads to | dysregulation of the body’s calcium homeostasis system, causes more bone to be dissolved to increase body calcium which can lead to weakened bones and fractures |
| stage of CKD: Kidney damage with normal or increased GFR (>=90) | 1 |
| stage of CKD: Kidney damage with mild decrease GFR (60-89) | 2 |
| major treatment decisions are made after GFR decreases below | 60 |
| stage of CKD: moderated decrease in GFR (30-59) | 3 |
| stage of CKD: severely decreased GFR (15-29) | 4 |
| stage of CKD: kidney failure (GFR<15, or on dialysis) | 5 |
| the best single quantitative diagnostic measure of the kidney’s ability to filter blood to remove wastes | GFR |
| estimated by determining creatinine clearance | GFR |
| Normal young adults exhibit glomerular filtration rates >__ mL/min/1.73 m2 | 90 |
| ___, not just ESRD, is a major risk for people with CKD | premature cardiovascular death |
| Most patients with CKD will die of events related to ___ before ESRD develops | cardiovascular disease |
| for diabetic kidney disease the CKD risk factors are | diabetes, HBP, family history, ethnic minority |
| glomerular disease risk factors for CKD | autoimmune dz, systemic infections, neoplasia, drug or chemical exposure, family history |
| vascular disease risk factors for CKD | HBP, family history, ethnic minority |
| positive correlation between ___ level and risk of CKD | A1C |
| according to the JNC 7 the BP goal for those with CAD or DM is | <130/80 |
| who to screen for chronic kidney disease | Diabetes, Hypertension, Relative with kidney failure, Cardiovascular disease |
| normal GFR __ml/min | 100 |
| ___ estimates GFR | creatinine clearance |
| formula used to estimate creatinine clearance | Cockcroft-Gault |
| ___ without GFR decline is the first sign of diabetic nephropathy | albuminuria |
| Once albuminuria develops, CKD follows predictable course with expected loss of __ ml/min GFR per year | 4 |
| in individuals with diabetest the ___ is the recommended test for CKD | spot urine albumin to creatinine ratio |
| diabetics should be tested for albuminuria ___ | once per year |
| degree of proteinuria predicts | rate of GFR decline |
| GFR tells you | how far you are from the cliff |
| proteinuria tells you | how fast you are approaching the cliff |
| goal #1 in slowing decline in GFR | get BP <130/80 |
| step one in getting BP below 130/80 | use and ACEI or ARB |
| when using and ACEI to reduce BP you need to | monitor serum potassium and serum creatinine |
| normal albumin/creatinine ration <__mg/g | 30 |
| inflammation/cytokine release leads to___ leading to anemia in CKD | inhibition of erythropoeitin, and apoptosis of erythroblast |
| anemia in males is defined as <__g/dL | 13.5 |
| anemia in females is defined as <__g/dL | 12 |
| Hgb target in pateints with CKD __g/dL | 11-12 not to exceed 13 |
| with anemic CKD patients sufficient iron should be administered to maintain a TSAT of >=__% and a serum ferritin level of >=__ng/ml | 20, 100 |
| if your patient has excess phosphate retention you can give a | phosphate binder |
| vitamin D falls ___ in CKD | early |
| PTH ___ early in CKD | early |
| normal PTH is | 70-110 |
Created by:
bwyche
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