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Questions and Answers

What can sustained increases in plasma flow and hydrostatic pressure lead to?

  • Renal hypertrophy
  • Increased urine output
  • Hyper-filtration injury and glomerular sclerosis (correct)
  • Improved nephron function

    • Which of the following is NOT a marker for kidney damage that can help establish a diagnosis in CKD stages 1 and 2?

  • Decreased GFR (correct)
  • Albuminuria
  • Electrolyte abnormalities
  • Structural abnormalities detected by imaging

    • Which combination is advised by the NKF to evaluate risks for AKI, ESRD, and progressive CKD?

  • GFR and serum potassium
  • GFR and albuminuria (correct)
  • Creatinine and electrolytes
  • BUN and bicarbonate levels

    • What is a common symptom of CKD in more severe stages (4-5)?

    <p>Fatigue (B)</p> Signup and view all the answers

    Which electrolytes are typically increased during the clinical presentation of advanced CKD?

    <p>Potassium and phosphorus (C)</p> Signup and view all the answers

    Which of the following is a laboratory test indicative of proteinuria in advanced CKD?

    <p>Albumin-to-creatinine ratio (ACR) (D)</p> Signup and view all the answers

    What is a potential effect of metabolic acidosis in CKD patients?

    <p>Decreased transferrin saturation (B)</p> Signup and view all the answers

    Why is a high level of suspicion necessary for diagnosing CKD in early stages?

    <p>CKD is often asymptomatic until advanced stages (D)</p> Signup and view all the answers

    What does a chronic kidney disease diagnosis require in terms of GFR?

    <p>GFR &lt; 60 mL/min/1.73 m2 for ≥ 3 months (D)</p> Signup and view all the answers

    Which of the following is NOT a common cause of chronic kidney disease?

    <p>Acute Tubular Necrosis (C)</p> Signup and view all the answers

    What role does Angiotensin II play in the pathophysiology of chronic kidney disease?

    <p>It contributes to the constriction of efferent arterioles. (B)</p> Signup and view all the answers

    Which factors are used for classifying chronic kidney disease stages?

    <p>eGFR and ACR (C)</p> Signup and view all the answers

    What is one of the main functions of the kidneys related to homeostasis?

    <p>Regulation of electrolyte balance (B)</p> Signup and view all the answers

    Which hormone is secreted by the kidneys to stimulate red blood cell production?

    <p>Erythropoietin (A)</p> Signup and view all the answers

    What compensatory mechanism occurs in the kidneys due to reduced nephron mass?

    <p>Increased blood flow to the kidneys (C)</p> Signup and view all the answers

    What defines the structural or functional abnormalities of the kidney necessary for a chronic kidney disease diagnosis?

    <p>Kidney damage for at least 3 months (B)</p> Signup and view all the answers

    What is one of the primary goals of chronic kidney disease management?

    <p>Prevent or slow the progression of kidney disease (C)</p> Signup and view all the answers

    Which drug class is contraindicated for male patients with chronic kidney disease if serum creatinine exceeds 1.5 mg/dl?

    <p>Biguanides (A)</p> Signup and view all the answers

    What dietary restriction is recommended for patients with chronic kidney disease to manage protein intake?

    <p>0.6g/kg/day (D)</p> Signup and view all the answers

    How frequently should individuals with chronic kidney disease be screened for urine albumin excretion?

    <p>Once every year (D)</p> Signup and view all the answers

    What lifestyle modification is recommended for managing hypertension in patients with chronic kidney disease?

    <p>Maintain a reduced blood pressure ≤ 130/80 (D)</p> Signup and view all the answers

    Which adverse effect is associated with the use of rosiglitazone in patients with chronic kidney disease?

    <p>Volume retention (A)</p> Signup and view all the answers

    When should amylin analogs, such as pramlintide, be considered for patients with chronic kidney disease?

    <p>When GFR is below 20 ml/min/1.73m2 (C)</p> Signup and view all the answers

    What is a common secondary complication of decreased kidney function?

    <p>Heart failure (D)</p> Signup and view all the answers

    What is the recommended exercise frequency for individuals with chronic kidney disease to achieve health benefits?

    <p>30 minutes five times a week (B)</p> Signup and view all the answers

    Which medication is indicated for intensifying glycemic control in patients with chronic kidney disease?

    <p>Continuous SC insulin infusion with a pump (D)</p> Signup and view all the answers

    Which type of dietary modification is suggested for managing hyperlipidemia in patients with chronic kidney disease?

    <p>Dietary restriction of cholesterol (B)</p> Signup and view all the answers

    What is a likely effect of untreated dyslipidemia in patients with chronic kidney disease?

    <p>Increased risk of cardiovascular events (A)</p> Signup and view all the answers

    What common condition is prevalent in patients with chronic kidney disease concerning triglycerides?

    <p>High triglycerides (B)</p> Signup and view all the answers

    Study Notes

    Chronic Kidney Disease (CKD) Definition & Classification

    • CKD is defined as kidney damage for ≥ 3 months, using histology, imaging or laboratory assessments, with or without decreased GFR, OR GFR < 60 mL/min/1.73 m2 for ≥ 3 months, with or without kidney damage.
    • CKD is classified into five stages (G1-G5) based on estimated glomerular filtration rate (eGFR) and three stages (A1-A3) based on albumin:creatinine ratio (ACR).

    Pathophysiology of Progressive Kidney Disease

    • Reduced nephron mass (due to diabetes, hypertension, glomerulonephritis, etc.) leads to compensatory vasodilation of the afferent arteriole (by prostaglandins) and constriction of the efferent arteriole (by Angiotensin II).
    • This causes increased blood flow, single nephron intra-glomerular capillary filtration pressure, and hyper-filtration (increased single nephron GFR).
    • Sustained increases in plasma flow and hydrostatic pressure lead to hyper-filtration injury and glomerular sclerosis, resulting in continued loss of nephron function.

    Diagnostic Criteria for Progressive Kidney Disease

    • Progressive increase in serum creatinine (consider factors that may alter serum creatinine: decreased muscle mass & nutritional status).
    • Decreased GFR
    • In stage 1 and 2 CKD, reduced GFR is not enough for diagnosis.
    • The markers of kidney damage that establish the diagnosis include: albuminuria (albumin excretion >30 mg/24 hr or albumin:creatinine ratio >30 mg/g [>3 mg/mmol]), urine sediment abnormalities, electrolyte and other abnormalities due to tubular disorders, and structural abnormalities detected by imaging.

    Clinical Presentation of CKD

    • CKD is often asymptomatic until stages 4 or 5.
    • Early diagnosis requires a high level of suspicion in patients with chronic conditions such as hypertension or diabetes.
    • Clinical presentation (signs and symptoms): fatigue, weakness, shortness of breath, mental confusion, nausea and vomiting, bleeding, loss of appetite, edema, weight gain, changes in urine output and consistency, "foaming" of urine (indicative of proteinuria), and itching.
    • Laboratory test findings: decreased eGFR, decreased bicarbonate (metabolic acidosis), increased serum creatinine, increased BUN, increased potassium, increased phosphorus, decreased Hb/hematocrit (Hct) (TSat), decreased Transferrin saturation (anemia), decreased ferritin, increased ACR, increased blood pressure, decreased Vitamin D levels, decreased albumin, decreased glucose (malnutrition), and increased calcium (in early stages of CKD).

    Goals of CKD Management

    • Prevent or slow the progression of kidney disease.
    • Evaluate and manage comorbid conditions.
    • Review medication regimen regularly.
    • Prevent and treat cardiovascular disease.
    • Prevent and treat secondary complications of decreased kidney function.
    • Prepare for kidney failure and kidney replacement therapy as needed.
    • Replace kidney function with dialysis or transplantation, if needed.

    Treatment of CKD

    • General Approach: General approach includes non-pharmacologic recommendations for individuals with CKD, drug management, correction of hyperlipidemia, and management of diabetes, hypertension, and proteinuria.
    • Non-pharmacologic recommendations: exercise 30 minutes five times a week to achieve a BMI < 25kg/m2, avoid smoking, and avoid excessive alcohol consumption.
    • Drug management: The text details medication management considerations for patients with moderately to severe CKD, including information on Metformin, TZDs, Meglitinides, Incretin mimetic, Amylin Analog, and Dipeptidyl peptidase IV inhibitor, including their use with different GFR levels and dialysis conditions.
    • Correction of Hyperlipidemia: Increased cholesterol (particularly LDL) correlates with the decline in kidney function, and increased triglycerides are prevalent in patients with CKD.
    • Management of Diabetes: The text includes information on dietary protein restriction, blood pressure control, intensification of glycemic control, and management of microalbuminuria and albuminuria for patients with diabetes.
    • Management of Hypertension: The text discusses the use of ACEI or ARB therapy for management of hypertension for patients with CKD.

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