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DU PA Chronic K Dz

Duke PA Chronic Kidney Disease

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