Term
| What do Stages 1 and 2 of CKD represent? |
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Definition
1. Kidney Damage with normal or increased GFR
2. Mild Decrease GFR |
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Term
| What are the risk factors and consequences of CKD? |
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Definition
Susceptibility
Inc. age, low birth weight, small kidneys, racial minority,
FH, low income, low education, systemic inflammation,
dyslipidemia
Initiation
DM, HTN, GN
Progression
Glycemia, HTN, proteinuria, smoking, obesity
Consequences
Associatead with high prevalence of CVD, HTN, Anemia, increased mortality
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Term
| What are the action plans at each of the five stages of CKD? |
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Definition
@ Risk - Screening, CKD risk reduction
1 - Diagnose/Tx of CKD, Tx comorbid conditions, slow progression, Dec. CVD risk
2 - Estimate progression
3 - Evaluate and Tx complications
4 - Prepare for KRT
5 - Provide KRT |
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Term
| What is DKD and what are its complications? |
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Definition
DKD - Diabetic Kidney Disease
- Vascular changes in the kidney
- Proteinuria and declining GFR
- Patients may also have DM + another cause of CKD
- If the patient HAS DM, they are at a higher risk for progression of CKD |
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Term
| How do we screen for DKD? |
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Definition
- Urinary Albumin excretion
- Serum Creatinine
- Screen annually, and if diagnosed with T1DM screen 5 years after diagnosis, and with T2DM screen AT diagnosis |
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Term
| In terms of microvascular complications, stroke, death, and any DM endpoint, which is more effective: Tight blood glucose control or tight blood pressure control |
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Definition
| - In various studies, tight blood glucose control shows a statistically significant decrease in complications of DM/HTN patients. |
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Term
| What is the difference between micro- and macroalbuminuria? |
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Definition
Micro - occurs when the kidney leaks small amounts of albumin into the urine, in other words, when there is an abnormally high permeability for albumin in the renal glomerulus.
Macro - Microalbuminuria is diagnosed either from a 24-hour urine collection (20 to 200 µg/min) or, more commonly, from elevated concentrations (30 to 300 mg/L) on at least two occasions.[1]. An albumin level above these values is called "macroalbuminuria", or sometimes just albuminuria. |
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Term
| For a 24h and spot albumin creatinine collection, what levels represent microalbuminuria? |
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Definition
30-300
Any higher in the 24h collection is Albuminuria |
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Term
| For a 24h and spot albumin creatinine collection, what levels represent Proteinuria? |
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Definition
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Term
| What are the treatments for micro/macroalbuminuria? |
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Definition
T1DM
+ HTN + micro/macro- ACEi
albuminuria
T2DM + HTN + microalbuminuria ACEi or ARB
T2DM
+ HTN +
macroalbuminuria + ARB
SCr>1.5mg/dl
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Term
| What is glomerulonephritis? |
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Definition
- Blanket term to describe many diseases
- S/S generally classified into Nephritic/Nephrotic |
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Term
| What is the difference between nephritic and nephrotic symptoms? |
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Definition
Nephritic - "ITIS" means inflammation
- Hematuria
- Proteinuria
Nephrotic - Proteinuria (>3.5g/day), edema, hyperlipidemia, hypercoagulable state |
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Term
| What does Urinalysis and bloodwork yeild if a patient has Nephritic syndrome? |
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Definition
Urinalysis - Proteinuria (>3g/day), Cellular casts, Granular casts
Bloodwork - GFR decline if glomerular surface is reduced, hypoproteinemia, hypercoagulabe state (some patients) |
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Term
| What are therapeutic options in non-DM CKD? |
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Definition
- Corticosteroids
- Cyclophosphamide
- Cyclosporine
- Mycophenolate |
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Term
| What are our roles as pharmacists in the treatment of CKD? |
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Definition
- Identify those with or at risk for CKD
- Recommend screening (i.e. PCP, KEEP)
- Educate the patient / increase awareness of CKD
- Identify appropriate progression-modifying
- interventions
- Reconcile medication lists
- Optimize medication use
Patient-focused (adherence)
Provider-focused
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Term
| How do we identify patients with CKD? |
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Definition
Medications for initiation factors
(i.e. DM/HTN)
Rx from a nephrologists
Dose adjusted medications in the Rx profile
Receipt of CKD-specific medications
(i.e. phosphate binders, calcimimetic agent, active Vit
D, etc)
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