CKDelic
In the KDIGO definition, abnormalities to kidney structure or function classified by albuminuria or GFR must be present for how long for CKD to be defined?
What is 3 months.
What is the goal BP for CKD patients as per the KDIGO 2012 and AHA/ACC 2017 Hypertension guidelines?
What is <130/80
Mineral and bone disorders as per the most recent KDIGO 2017 CKD update on mineral and bone disorders (CKD-MBD) guideline replaced the term renal osteodystrophy. It has three main types based on bone biopsy which is the gold standard for diagnosis. What are the three main types?
What are osteitis fibrosa, osteomalacia, and dynamic bone disease.
What is the most common type of stone?
What is Calcium Oxalate
Per the KDIGO 2012 Anemia in CKD guideline, at this transferrin saturation and at this ferritin value we can consider starting iron supplementation.
What is when the Transferrin saturation is ≤30% and ferritin is ≤500 ng/ml (500 mg/l).
Besides Diabetes and hypertension, name 3 other causes of CKD.
What are Drug-toxicities, Autoimmune diseases, Systemic infections, Family history of CKD, Lower urinary tract obstruction, Hyperuricemia, Nephrolithiasis, and Kidney transplantation
Besides ACEi and ARBs, this specific class of medications have been shown to decrease proteinuria.
What are non-dihydropyridine calcium channel blockers.
This agent for hyperphosphatemia works as an anion exchange resin.
What is Sevelamer
Struvite stones are due to UTIs from urea splitting organisms. What are the 2 main organisms responsible?
What are Proteus and Klebsiella
What are 2 classes of medications that can be added as therapy for diabetic patients with CKD (with a eGFR >30)?
What are GLP-1 RA and SGLT2
Base is suggested when serum bicarbonate concentration is <___ mEq/L, but the target serum bicarbonate concentration remains unclear.
What is 22.
For CKD patients on diuretics, at what point do we switch from thiazides to loops?
What is a creatinine clearance <30
True or False: the 2017 CKD-BMD guideline noted that 4 prospective studies had shown benefit of DEXA studies in CKD patients and also showed benefit of using osteoporosis medications to treat the condition.
What is false. While there was 4 studies to show benefit of DEXA there was concern that usage of bisphosphonates and RANK-L agents (eg Denosumab) will likely lower calcium level in the blood further and thus lead to increased PTH release
Name 2 conditions associated with hyperoxaluria
What are
malabsorption (Crohn's) or anatomical abnormalities (gastric bypass)
The cut off for LDL value for which no calculation of ASCVD risk is needed to begin statin therapy
What is 190 mg/dL
At this CKD stage and its associated GFR of ___ to ___ all patients should be seen and followed by a nephrologist.
What is CKD stage 4 and what are 15 to 29
ACEi and ARBs are first line agents for proteinuria in CKD. A reduction in protein excretion to less than ____ to ____ mg/day is associated with slowing of progression of CKD.
What are 300 and 500 mg/day.
While previous KDIGO use to recommend primary usage of calcium agents without restrictions in dosing amounts in controlling hyperphosphatemia, this was recently changed in the 2017 CKD BMD guidelines recommend restricting the *dose* of calcium-based phosphate binders. What was this done for?
What is due to concerns of coronary calcification and multiple studies showing an increase in non-fatal CV events
True or False: Dual therapy with thiazides and allopurinol or thiazides with citrate was shown to be more successful at prevention for recurrent stones than thiazides as monotherapy.
What is false
An abnormal ABI is defined as less than or equal to this number
What is 0.90
While we normally associate casts with AKIs, these two types of casts are associated with CKD.
What are
1.)Waxy casts (last stage in the degeneration of granular cast)
2.) Broad casts (it is thought they are due to large dilated tubules with little flow, hence they are associated with advanced chronic kidney disease)
Older Dihydropyrine CCB affect only L type calcium channels. These two new calcium channel blockers affect the N and T type calcium channels as well.
What are efonidipine and benedipine
The 2017 KDIGO CKD-BMD guidelines recommends to use calcimimetics, calcitriol, or vitamin D analogues or a combinations in CKD G5D if they require PTH lowering therapy based on the EVOLVE trial. Per the EVOLVE trial, the unadjusted primary endpoint (time to death/all-cause mortality, non fatal MI, hospitalization for unstable angina, CHF, and peripheral vascular events) had a statistically non-significant reduction. However there was a statistically significant reduction in this group of patients.
What is older-age individuals.
Of the three mainstay medications, this medication has been shown to reduce the composite relative risk of recurrence of stones in patients with hypercalciuria by near half (RR 0.52).
What are thiazides
Mr.CK D'beetus is a 48 yo man with pmh of HTN, DM type 2, hyperlipidemia, and stage 3A CKD who presents to your clinic in October. He received his childhood vaccines but has never received other vaccines. What vaccines should he receive first today?
What are Prevnar 13 (then 8 weeks later a PPSV 23), Hepatitis B series, TDAP, Influenza.