chronic kidney disease

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Author:
Ambestul
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15778
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chronic kidney disease
Updated:
2010-04-28 20:56:40
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exam 3
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  1. standardized definition/diagnosis of CKD
    structural or functional abnormalities of the kidneys for >=3 mo and manifested by either: kidney damage OR GFR <60ml/hr/1.73m2
  2. markers of kidney damage
    • urine protein (albumin of globulin)
    • albuminuria (normal <30mg/gmCr)
    • -microalbuminuria 30-300
    • -macro >300
  3. when to use MDRD
    for screening and staging of CKD, ages 18-70yo, pts with diabetic kidney disease, chronic kidney disease in middle age, blacks with hypertensive chronic kidney disease, pts with kidney transplant
  4. when to use cockccroft-gault eq
    used 4 adjusting drug therapy, preferred method, older pts
  5. 24 hr urine-situations for use
    extremeties of age, prego, malnutrition, skeletal muscle disease, para or quadriplegic, vegetarians and people with rapidly changing kidney fxn
  6. etiology-susceptibility factors for CKD
    • elderly >60
    • familyy hx of CKD
    • ethnic minorities-african amer(4X), american indian (2X), hispanic (1.5), alaskan
    • low income or education
  7. etiology-initiation risk factors
    • diabetes(40-50% risk of CKD)
    • HTN(systolic more indicative)
    • autoimm disease
    • envir toxins (i.e. heavy metal
    • drug toxicity
  8. etiology-progression risk factors
    • uncontrolled proteinuria
    • uncontrolled BP
    • poor glycemic control
    • smoking
    • -all associated with a faster rate of GFR decrease
  9. incidence of kidney failure by primary diagnosis in descending order
    • diabetes
    • HTN
    • glomerulonephritis
    • cystic kidney disease
  10. stage 1 kidney disease-description and GFR
    kidney damage prob with markers with normal or dec GFR, >=90ml/min
  11. stage 2 CKD-desc and GFR
    kidney damage with mild decr GFR, 60-89ml/min
  12. stage 3 CKD, desc and GFR
    mod decr GFR, 30-59
  13. stage 4 CKD desc and GFR
    severe decr GFR, 15-29ml/min
  14. stage 5 desc and GFR
    kidney failure, <15 or RRT
  15. signs and sx of waste remove dysfxn
    uremia and malnutrition
  16. signs and sx of RBC formation dysfxn
    anemia
  17. signs and sx of bone health dysfxn
    renal osteodystrophy
  18. signs and sx of acid base misbalance
    metabolic acidosis is most common
  19. signs and sx of fluid and electrolyte imbalance
    dehy, edema
  20. complications of stage 1 CKD
    complications from initiating insult to kidneys
  21. complications of stage 2 CKD
    HTN-also initiation factor and complication of CKD because CKD progression can result in HTN if not treated appropriately
  22. complications of stage 3 CKD
    anemia, mild decr in serum calcium
  23. complications of stage 4 CKD
    • hyperphosphatemia
    • renal bone disease
    • dyslipidemia
    • neuropathy
    • left ventricular hypertrophy
  24. complications of stage 5 CKD
    uremia, malnutrition, metabolic acidosis
  25. traditional risk factors for CVD risk factors in CKD
    advanced age, male, HTN, dyslipidemia, DM, tobacco use, menopause
  26. CKD-related risk factors for CVD risk
    decr GFR, proteinuria, RAAS overactivity, fluid overload, abn calc and phos metabolism, anemia, inflammation, uremic toxins, homocysteinemia, malnutrition
  27. assess for CKD risk
    • socio-demographic profile(older age, ethnic background, low income/education, family history)
    • AND
    • clinical profile(DM, HTN, autoimm diseases, recovery from acute renal failure-envir or drug-induced)
  28. evaluation of CKD-if at risk
    • estimate GFR using MDRD,
    • screen for proteinuria(albumin)-diabetes age 12-70 annually, pts with uncontrolled BP, persons with FH of CKD or >60 yrs of age of belong to ethnic risk group,
    • stage,
    • identify complications,
    • screen for co-morbid conditions
  29. persistent proteinuria (albumin)
    make sure persistent b4 make an intervention, albumin excretion >30 mg on 2 or more consecutive urine samples separated by at least 1-2 weeks
  30. disease management goals
    • prevention
    • slow progression
    • prevent and treat complications
    • manage co-morbidities
    • timely referral
    • RRT
  31. goal urea-reduction ratio (URR)
    >=65%, reduction in urea from pre-dialysis to post-dialysis
  32. goal kinetic modeling formula Kt/V
    >=1.2, determines adequecy of dialysis
  33. dextrose soln euvolemic
    1.5%
  34. dextrose soln-edema
    2.5%
  35. dextrose soln-edema + SOB
    3.86%
  36. dextrose soln-severe SOB
    4.25%
  37. volume PD dialysate-small
    1-1.5L
  38. volume PD dialysate-average
    2L
  39. volume PD dialysate, large
    2.5-3L
  40. points for antigen mismatch
    0-2 points, lower number of ags, higher points
  41. time waiting
    1 point per yr
  42. panel reactive antibody >=80%
    4 ppints
  43. pediatric points
    3-4 points
  44. previous living donation
    4 points
  45. delayed graft fxn
    need for dialysis in the postop period or the failure of the serum cr to fall below 4mg/dl or 30% ofo pre-transplant value
  46. basiliximab (simulect), Daclizumab (Zenapax)
    2nd dose anaphylaxis, moAb
  47. muromonab (OKT3)
    1st dose rxn-cytokine release-give benadryl prophylaxis, moAb
  48. antithymocyte globulin
    ATG-rabbit, ATGAM-equine, not equiv, thrombocy, leukopenia, polyclonal ab
  49. SEs of CSs
    HTN, edema, wt gain, hyperglyc, osteopor, cataracts, leukocytosis, hypophos, delayed wound healing, acne, steroid psychosis, adren insuff, cushing's, growth retard, N/V
  50. azathioprine (AZA)
    leukopenia, anemia, thrombocytopenia, lots of drug INX
  51. mycophenolate mofetil (MMF, CellCept)
    GI (N/V/D), delayed wound healing, drug inx w antacids, iron, acyclovir
  52. cyclosporine
    sandimmune and neoral w/ generics, CNS toxicity (tremor, seizures), nephrotox, hyperkal, hypomag, htn, dyslipi, gingivial hyperplasia, hirsutism
  53. tacrolimus, Prograf
    similar SE to CsA plus plus transplant DM, similar drug inx to CsA
  54. sirolimus
    profound dyslipidemia

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