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 |