Term
|
Definition
•The presence of markers of kidney damage for > three months, such as abnormalities in the composition of blood or urine, or abnormalities on imaging tests
OR
•The presence of a GFR of less than 60 mL/min/1.73 m2 for > 3 months with or without other signs of kidney damage.
. |
|
|
Term
| What is the most common cause for CKD in the US? |
|
Definition
|
|
Term
| Between the ages of 35 and 55, the GFR drops by approximately . . . |
|
Definition
|
|
Term
| serum creatinine becomes less predictive of renal function as age increases due to . . . |
|
Definition
| decreased muscle mass and creatinine generation associated with advancing age. |
|
|
Term
| Both hepatitis B and C can result in CKD, typically . . . (what two kidney diseases?) |
|
Definition
| membranous nephropathy or membranoproliferative glomerulonephritis |
|
|
Term
| Patients chronically infected with hepatitis B may also develop __________, while those chronically infected with hepatitis C may also develop ____________ |
|
Definition
polyarteritis nodosa
cryoglobulinemia |
|
|
Term
| What is cryoglobulinemia? |
|
Definition
| condition in which the blood contains large amounts of cryoglobulins - proteins (mostly immunoglobulins themselves) that become insoluble at reduced temperatures. Cryoglobulinemia can be associated with various diseases such as multiple myeloma and hepatitis C infection. |
|
|
Term
| patients with advanced liver disease are also at increased risk for developing . . . |
|
Definition
| CKD due to compensatory hemodynamic changes that occur in cirrhosis. |
|
|
Term
| The most common cause of analgesic nephropathy historically has been the combination of . . . |
|
Definition
| acetaminophen and aspirin |
|
|
Term
| Onset of analgesic nephropathy is insidious, often beginning as . . . |
|
Definition
|
|
Term
| Individuals with an activated renin-angiotensin system are at increased risk of developing . . . |
|
Definition
|
|
Term
| •CKD due to HIVAN responds to . . . |
|
Definition
|
|
Term
| To assess kidney function, the clinician should measure . . . |
|
Definition
serum creatinine
GFR
urinary sediment
daily urine albumin or protein excretion |
|
|
Term
| The normal GFR in young adults is approximately . . . |
|
Definition
|
|
Term
| These creatinine-based estimates of GFR are not perfect and are affected by . . . |
|
Definition
nutritional status
dietary intake
muscle mass |
|
|
Term
| the least biased of the methods available to estimate the GFR is which equation? |
|
Definition
|
|
Term
| •Estimates of GFR are not useful in patients with . . . |
|
Definition
AKI
extremes of age and body size significant proteinuria |
|
|
Term
| In the normal person, daily urinary albumin loss is ___________, and protein loss is usually less than _______ |
|
Definition
albumin less than 20mg
protein loss less than 150 mg |
|
|
Term
| What is the earliest sign of kideny disease? |
|
Definition
|
|
Term
| urine dipsticks are insensitive for detecting . . . such as . . . |
|
Definition
non-albumin proteins
monoclonal immunoglobulins excreted in multiple myeloma. |
|
|
Term
If you suspect CKD what is the first test you get?
The second? |
|
Definition
|
|
Term
| How do you calculate a spot protein/creatinine ratio? |
|
Definition
| (Urine Protein)/(Urine Creatinine)multiplied by 1000 |
|
|
Term
| What are causes of transient proteinuria? |
|
Definition
upright position
exercise
fever
dehydration |
|
|
Term
| protein/creatinine estimates what? |
|
Definition
| 24 hour urine protein in mg |
|
|
Term
| Albuminuria is a marker for increased risk of _____________ has been associated with increased risk for acute kidney injury and CKD progression independent of kidney function. |
|
Definition
|
|
Term
| Albuminuria has been associated with increased risk for ____________ and ____________ independent of kidney function. |
|
Definition
acute kidney injury
CKD progression |
|
|
Term
| The spot urine protein/ creatinine may ___________ the 24H urine protein excretion in those with higher extremes of muscle mass. |
|
Definition
underestimate
(protein/creatinine)= bottom number gets bigger and decreases the ratio |
|
|
Term
| use of the spot urine protein/creatinine ratio should be avoided in individuals with ___________ |
|
Definition
|
|
Term
| As urinary creatinine excretion is variably __________ in AKI, and the spot urine protein/ creatinine ratio may grossly __________ 24H protein excretion. |
|
Definition
|
|
Term
What is considered a NORMAL albumin/creatinine ratio?
Moderately elevated?
Severely increased? |
|
Definition
< 30 mg/g
30-300 mg/g
>300mg/g |
|
|
Term
What is considered a NORMAL protein/creatinine ratio?
What is abnormal? |
|
Definition
|
|
Term
| What is a NORMAL 24 hour protein? |
|
Definition
|
|
Term
| What is preferred protein or albumin spot urine? |
|
Definition
| ALBUMIN, unless >500 or protein is believed to something other than albumin |
|
|
Term
| Estimated GFR is the best marker of __________; whereas persistent albuminuria is the best marker of __________ |
|
Definition
kidney function
kidney damage |
|
|
Term
| All abnormal results should be __________________ |
|
Definition
| CONFIRMED on a separate occasion within THREE MONTHS. |
|
|
Term
| Does a normal GFR in the face of albuminuria exclude kidney damage? |
|
Definition
|
|
Term
| What are the causes of BILATERALLY SMALL kidneys? |
|
Definition
HTN
Chronic Glomerulonephritis
Bilateral renal artery stenosis
analgesis nephropathy |
|
|
Term
| What are the causes of BILATERALLY LARGE SMOOTH kidneys? |
|
Definition
diabetic nephropathy
infiltrative disease (amyloidosis) |
|
|
Term
| What are the causes of UNILATERAL SMALL SCARRED kidney? |
|
Definition
Previous renal surgery/trauma
Unilateral renal artery stenosis
Reflux nephropathy |
|
|
Term
| What is the cause of large cystic kidneys? |
|
Definition
Normal variant
polycystic kidney disease
Renal Cell carcinoma (usually solitary mass) |
|
|
Term
| •Sequelae and management of CKD is ___________, hence individuals with CKD should be categorized by ____ and __________. |
|
Definition
stage-dependent
GFR
albuminuria level |
|
|
Term
| •CKD is categorized by both GFR and albuminuria level to better capture risk of ____________ |
|
Definition
|
|
Term
| What is the primary cause of death in pt's with CKD? |
|
Definition
|
|
Term
| What is the goal BP in CKD? |
|
Definition
BP< 140/90
BP< 130/80 if albuminuria is present |
|
|
Term
| What stage is somone with a GFR of >/90 (normal high) |
|
Definition
|
|
Term
| What stage is somone with a GFR of 60-89? (mildly decreased) |
|
Definition
|
|
Term
| What stage is somone with a GFR of 45-59 (mild to moderately decreased) |
|
Definition
|
|
Term
| What stage is somone with a GFR of 40-44 (moderately to severely decreased) |
|
Definition
|
|
Term
| GFR 15-29 (Severely decreased) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| A patient presenting with CKD who has diabetes, persistent albuminuria, and diabetic retinopathy can be diagnosed with _______________ without _______________ |
|
Definition
diabetic nephropathy
renal biopsy, unless clinical evidence suggests another etiology |
|
|
Term
| mortality is doubled in patients with CKD and a hematocrit of less than _______. |
|
Definition
|
|
Term
TRUE OR FALSE:
There is no value in checking serum erythropoietin levels in pts with CKD; |
|
Definition
| TRUE, they are typically elevated in CKD but insufficiently so relative to the level of anemia |
|
|
Term
| Anemia due to CKD is therefore treated as a diagnosis of __________ |
|
Definition
| exclusion; iron deficiency and other causes should be evaluated. |
|
|
Term
| The FDA has approved use of an ESA when hemoglobin falls below ______ |
|
Definition
|
|
Term
| What are the potential adverse SE of useing Erythropoetin Stimulating Agents (ESAs)? |
|
Definition
| Cardiovascular event, stroke, and death |
|
|
Term
| Due to the SE of ESAs, the FDA recommendation of reducing the dose or withholding ESAs when hemoglobin . . . |
|
Definition
| exceeds 10 g/dl or increases by greater than 1g/dl in a 2-week period. |
|
|
Term
| •Screening for anemia begins with category . . . |
|
Definition
|
|
Term
| •Patients with CKD are more prone to volume overload if . . . |
|
Definition
| sodium intake is not controlled |
|
|
Term
| •If indicated, potassium is restricted to . . . |
|
Definition
|
|
Term
| •Sodium bicarbonate is indicated (0.5-1mg/kg/day) when serum bicarbonate falls to . . . |
|
Definition
|
|
Term
| •The effects of protein restriction on progression of CKD are ________, and only in those with GFR category _____ or worse. |
|
Definition
|
|
Term
| Phosphorus is restritcted in CKD when the serum Ph reaches . . . |
|
Definition
|
|
Term
| Calcium intake in CKD is . . . |
|
Definition
|
|
Term
| What acid/base disturbance typically occurs in patients with CKD? |
|
Definition
|
|
Term
| Metabolic acidosis in CKD occura due to . . . |
|
Definition
| impaired hydrogen ion excretion by the kidneys |
|
|
Term
| recommended that once a patient's GFR declines below _______, screening for malnutrition with serum _______ and __________ be done _________. |
|
Definition
20
albumin
body weight
quarterly |
|
|
Term
| •In CKD, the kidneys lose their ability to convert vitamin D (i.e., 25OH vitamin D) into its . . . |
|
Definition
| active form (i.e., 1, 25OH vitamin D). |
|
|
Term
| •As a result of CKD, calcium levels _____, phosphorous levels ______, and iPTH levels ______ to counteract these changes |
|
Definition
calcium falls
phosphorous rises
iPTH levels rise |
|
|
Term
| •If the electrolyte disturbances found in CKD (calcium and phos) are left untreated, what will develop? |
|
Definition
|
|
Term
| •In GFR categories 3b-5 (GFR <45 ml/min), the goal is to keep calcium and phosphorus in the . . . |
|
Definition
|
|
Term
| Assessment for mineral and bone disorder begins when the GFR falls below _______ |
|
Definition
|
|
Term
| All patients with GFR category G3b-G5 should undergo measurement of serum ________,________ , _________, and _______ at least once. |
|
Definition
| calcium, phosphorus, 25-OH vitamin D, and iPTH |
|
|
Term
| target goal and management of 25-OH vitamin D is . . . |
|
Definition
| target goal of 30ng/ml or greater. |
|
|
Term
| If hypercalcemia is accompanied by an elevated initial iPTH, evaluation for . . . |
|
Definition
| primary hyperparathyroidism should be considered |
|
|
Term
| If the calcium and phos levels in CKD are over treated, what may develop? |
|
Definition
|
|
Term
| Vitamin D guidelines for CKD pts is . . . |
|
Definition
| the same as the general population |
|
|
Term
| At what level of vitamin D do you give supplementation? |
|
Definition
| <20ng/ml are treated, but higher levels are not treated, regardless of iPTH levels. |
|
|
Term
| •Bone and mineral metabolism in CKD patients is assessed through evaluation of . . . |
|
Definition
| phosphorus levels (as opposed to iPTH levels) |
|
|
Term
| •Phosphorus levels should be maintained in the . . . |
|
Definition
|
|
Term
| •If phosphorus is elevated and calcium is low, treat with a . . . |
|
Definition
| calcium-based phosphate-binder. |
|
|
Term
| •If phosphorus is elevated and calcium is normal or high, treat with a . . . |
|
Definition
| non-calcium-based phosphate binder. |
|
|
Term
| 25-OH vitamin D level is >20ng/ml, vitamin D supplements or analogs are . . . |
|
Definition
| not indicated, even in those patients with elevated iPTH levels. |
|
|
Term
| hyperphosphatemia is one of the key contributors to __________ resulting in cardiovascular complications |
|
Definition
vascular calcification
cardiovascul |
|
|
Term
| For improved efficacy, patients should be instructed to ingest phosphate binders . . . |
|
Definition
| with, rather than before or after, meals. |
|
|
Term
| Secondary hyperparathyroidism associated with CKD typically presents with |
|
Definition
| LOW serum calcium, HIGH serum phosphorus, and HIGH iPTH. |
|
|
Term
| Secondary hyperparathyroidism associated with Vitamin D deficiency typically presents with |
|
Definition
| LOW serum calcium, LOW serum phosphorus, and HIGH iPTH. |
|
|
Term
| Within 10 years, _______ of patients with type 2 diabetes will have microalbuminuria. |
|
Definition
|
|
Term
| Hypertension in a patient with type 1 diabetes typically signifies the presence of ______________ |
|
Definition
|
|
Term
| The ACCORD study showed that treating patients with diabetes to goal blood pressure <120/80 mm Hg was associated with increased . . . |
|
Definition
| risk of syncope and worsening cardiovascular outcomes. |
|
|
Term
following blood pressure goals among diabetic patients:
•Without albuminuria: ___________
•With albuminuria (>30 mg/g): ___________ |
|
Definition
<140/90 mm Hg
<130/80 mm Hg |
|
|
Term
| ACEs and ARBs should be used with caution in those with GFR category ___________ |
|
Definition
|
|
Term
| How much of a decline in GFR is expected in patients who start an ACE-in or an ARB? |
|
Definition
30%
greater declines in GFR should prompt discontinuation of the drug and further investigation of its cause, such as renal artery stenosis. |
|
|
Term
| Other than ACE-inb and ARBs, what four classes of antihypertensives are beneficial in someone with CKD? |
|
Definition
•Diuretics
•Non-dihydropyridine calcium channel blockers (CCBs)
•Mineralocorticoid receptor blockers
•Direct renin inhibitors |
|
|
Term
| Thiazide diuretics are usually ineffective when the creatinine is . . . |
|
Definition
| >2mg/dl; consider using a loop diuretic in such cases. |
|
|
Term
| Non-dihydropyridine CCBs (e.g., verapamil, diltiazem), especially in combination with an ACE inhibitor or an ARB, are . . . |
|
Definition
| effective in reducing proteinuria in the hypertensive patient with proteinuria. |
|
|
Term
| Data suggest worse CKD progression in patients with systolic blood pressures . . . |
|
Definition
| below 110 mm Hg, so over-treatment of blood pressure should be avoided. |
|
|
Term
| once the GFR falls below 30 ml/min/1.73m2, a ________ is typically needed to treat fluid retention |
|
Definition
| loop diuretic (thiazides will be ineffective) |
|
|
