CKD Overview
In the absence of markers of kidney damage such as albuminuria or proteinuria, chronic kidney disease (CKD) is present when, for at least 3 months, the glomerular filtration rate is at or below:
60 ml/min
Kidney failure (GFR category 5 CKD) is defined as a glomerular filtration rate less than:
15 ml/min
What is the most common cause of death in CKD?
Cardiovascular disease
Supplementation of sodium bicarbonate is indicated when serum bicarbonate falls below this level?
< 22mEq
at 0.5-1 mg/kg/day
A CKDIIIA patient with elevated calcium, normal phosphorus, elevated intact-PTH, and normal VitD will falls into what category:
A: Hypervitaminosis with Vit D
B: Tertiary HyperPTH
C: Primary HyperPTH
D: Secondary HyperPTH
C: Primary HyperPTH
What are the two most common causes of CKD?
Hypertension
Diabetes
A normal 24h urine protein should not exceed _____?
< 150mg in 24h
A patient's 25OH Vitamin D level comes back at 12ng/ml, what are your recommendations for repletion?
800-1000 IU daily
The recommended maximum daily sodium intake for CKD patients is:
< 2g daily
A 56M with CKDIIIb has the following test results:
Ca 7.8mg/dl (normal 8.4-10.2mg/dl)
Phos 2.3mg/dl (normal 3.0-4.5mg/dl)
Intact PTH 100pg/ml (upper limit 55 pg/ml)
25OH Vit D 7ng/ml (normal >30ng/ml)
A: Diagnose primary hyperPTH and obtain parathyroid scan
B: Diagnose secondary hyperPTH and treat with VitD
C: Diagnose familial hypocalciuric hypocalcemia and obtain 24h urine Ca
D: Diagnose tertiary hyperPTH and arrange parathyroidectomy
B: Diagnose secondary hyperPTH and treat with VitD
The typical metabolic changes noted in patients with CKD include (Ca, Phos, PTH):
Hypocalcemia
Hyperphosphatemia
Elevated PTH
True or false:
Even with significant albuminuria, a normal eGFR will exclude the presence of any kidney damage
False
A patient with CKD is found to be anemic. When is therapy with erythropoietin (EPO) indicated? (Hgb value)
EPO should be initiated when Hgb < 10 g/dl
According to KDIGO guidelines, goal SBP in a patient with CKD is:
< 120 mmHg
During an initial visit with a new patient, you note that her labs show an elevated BUN and Cr. Her estimated GFR is 14 ml/min, unchanged from labs taken 6 months ago. As part of a prior workup for her kidney disease, she had undergone a renal US that revealed b/l enlarged kidneys but no renal cysts or hydronephrosis. The most likely cause of her CKD is:
A: HTN
B: Polycistic kidney disease
C: Interstitial nephritis
D: Diabetes
D: Diabetes
The upper limit of normal for urine protein/creatinine ratio on a spot collection is:
< 200 mg protein/gram creatinine
24h urine collection with 330mg albumin is :
A: Nephrotic syndrome
B: Normal
C: Severely increased
D: Moderately increased
C: Severely increased
_______ is a marker for increased risk of CVD in CKD patients
Albuminuria
As GFR falls below 15 ml/min, how often should providers be monitoring Calcium and Phosphorus levels?
Every 1-3 months
CKD patient with proteinuria develops cough with use of ACE inhibitor, and hyperK on an ARB. Name another therapeutic option that can slow progression of their proteinuria
Non-dihydropyridine CCB (Verapamil, Diltiazem)
The most accurate calculation of estimated glomerular filtration rate includes age, gender, and what other two criteria?
Serum creatinine and serum cystatin C
Per hopkins: __________ is the best marker of kidney function, and ___________ is the best marker of kidney damage
eGFR is the best marker of kidney function, and persistent albuminuria is the best marker of kidney damage
Management of hyperphosphatemia:
Recommendations are to avoid calcium-based phosphate binders as they may increase coronary artery calcification. Name an example of a non-calcium based phosphate binder (brand or generic)
Sevelamer carbonate (Renvela)
Lanthanum carbonate (Fosrenol)
A patient with DM is found to have proteinuria, and his eGFR is 22 ml/min. His serum phosphorus level is normal. What should his daily protein intake be? (g/kg body weight)
He should restrict his daily protein intake to 0.8g per kg of body weight
27F with lupus and CKD5 has the following blood results:
Ca 10.7mg/dl (normal 8.4-10.2mg/dl)
Phos 5.2mg/dl (normal 3.0-4.5mg/dl)
Intact PTH 852pg/ml (upper limit 55pg/ml)
25OH Vit D 43ng/ml (normal >30ng/ml)
The most likely diagnosis is
A: Primary hyperPTH
B: Secondary hyperPTH
C: Milk-Alkali syndrome
D: Tertiary hyperPTH
D: Tertiary hyperPTH