Renal: CKD

Card Set Information

Author:
jcbarbery
ID:
211176
Filename:
Renal: CKD
Updated:
2013-04-03 13:11:54
Tags:
renal kidney CKD
Folders:

Description:
Presentation, diagnosis and treatment of CKD
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user jcbarbery on FreezingBlue Flashcards. What would you like to do?


  1. CKD Definition
    • Albuminuria >3 months
    • Urine sediment abnormalities >3 months
    • Electrolyte abnormalities >3 months
    • Histological abnormalities >3 months
    • Imaging abnormalities >3 months
    • Kidney transplant Hx
    • GFR < 60 >3 months
  2. Susceptibility Factors
    • Older age
    • Dec. Kidney mass
    • Low birth weight
    • Family history of CKD
    • US ethnic minority status
    • Low income or education
  3. Initiation Factors
    • DM
    • HTN
    • Glomerulonephritis
  4. Progression Factors
    • Proteinuria
    • Poor glycemic control in diabetes
    • Elevated blood pressure
    • Smoking
    • Hyperlipidemia
    • Obesity
  5. Renal Assessment
    • Proteinuria (Main structural marker)
    • SCr
    • GFR
    • BP
    • Cholesterol
    • Symptoms
    • CBC
    • U/A
    • Imaging
    • Cystatin C
  6. GFR: G1
    ≥ 90; Normal/High
  7. GFR: G2
    60 – 89; Mildly decreased
  8. GFR: G3a
    • 45 – 59; Mildly to moderately decreased
    • Generally asymptomatic, HTN, anemia
  9. GFR: G3b
    • 30-44; Moderately to severely decreased
    • Generally asymptomatic, HTN, anemia
  10. GFR: G4
    • 15 – 29; Severely decreased
    • Nocturia, fatigue, cold intolerance, anorexia, hyperphosphatemia, hypocalcemia, metabolic acidosis
  11. GFR: G5
    • < 15 (or dialysis); Kidney failure
    • Malaise, lack of energy, pruritis, N/V, myoclonus, asterixis, seizures
  12. Albuminuria: A1
    AER & ACR <30; Normal to mildly increased
  13. Albuminuria: A2
    AER & ACR 30-300; Moderately increased
  14. Albuminuria: A3
    AER & ACR >300; Severely increased
  15. Progression (definition)
    • Dec. in GFR category w/ a 25% dec. from baseline
    • Sustained decline in eGFR of more than 5 / year
  16. Dietary Management
    0.8 g/kg/day protein if GFR <30
  17. Glycemic Control
    • A1c: ~7.0%
    • Preprandial 70-130
    • Postprandial <180
  18. HTN
    • ≤ 140/90 (ACR < 30)
    • ≤ 130/80 (>300; >30 w/DM)
  19. Pref. HTN Pharm Tx
    • DM or ACR > 30: ACEi or ARB
    • Non-DM & ACR < 30: diuretic
  20. Hyperlipidemia
    LDL <100
  21. Na/Fluid Imbalance
    • Dec. urine conc. ability
    • Dec. Na excretion -> volume overload

    Goal: Na 135-145 w/o volume overload/depletion
  22. Na/Fluid Tx
    • No-added-salt diet
    • Fluid restriction (dialysis; uncontrolled Na intake)
    • Diuretics (Loop +/- thiazide)
  23. Na/Fluid monitoring
    • BP
    • volume status
    • serum electrolytes

    frequency depends on location
  24. Potassium homeostasis
    Regulated by renal excretion, shifting in and out of cell, GI excretion

    Stage 4 – 5 body can no longer adapt
  25. K Goals
    • Stage 2 – 3: K of 3.5–5
    • Stage 4 – 5:K 4.5 - 6
  26. K Tx
    • Dietary restrictions
    • Prevent constipation
    • Eliminate medications likely to cause hyperkalemia
    • Sodium polystyrene sulfonate (Kayexelate®)
  27. Metabolic Acidosis (definition)
    • pH < 7.35
    • pCO2 <35
    • serum HCO3- < 24 mEq/L
  28. Metabolic Acidosis (pathophys)
    • dec. ammonia synthesis
    • -> dec. urinary buffer
    • -> dec. net H+ excretion
    • -> positive H+ balance
    • -> dec. pH
  29. Metabolic Acidosis (Sx)
    • Fatigue
    • Decreased exercise tolerance
    • Hyperkalemia
  30. Metabolic Acidosis (Goal)
    • Normalize pH
    • Maintain serum HCO3- of 22–28 mEq/L  
    • Prevent complications of severe acidosis (bone disease, decreased cardiac contractility)
  31. Metabolic Acidosis (Tx)
    • Asymptomatic pts w/ mild acidosis -> no Tx
    • Severe acidosis: pH < 7.2; HCO3- < 15
    • Tx recommended in pts w/ HCO3- < 22

    • Initial dosing depends on the calc. base deficit
    • Maintenance ~12-20 mEq/day

    Dialysis patients: adjust dialysate fluid
  32. Na Bicarb
    GI distress, hypokalemia, edama

    Can cause fluid retention

    IV: monitor ABGs q6-12h
  33. Na Citrate
    N/V/D, hyperkalemia

    Can cause fluid retention

    Promotes aluminum absorption
  34. K Citrate
    Hyperkalemia, hypernatremia, cardiac arrhythmias

    Promotes aluminum absorption

    Do Not use in pt w/ ­ high K

What would you like to do?

Home > Flashcards > Print Preview