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Chronic Kidney Disease (Complication management (Anemia of chronic disease…

- - - - ANA
        
        anti phospholipid Abs
        
        C3, C4, ESR
        
        Hepatitis panel/HIV
        
        Older than 35y
        
        A1c
        
        Other tests:
        
        Anemia
        
        CBC
        
        Hyperphosphatemia
        
        PO4
- - - - :warning:EPO is not diagnostic
        
        Pt presents asymptomatic
        
        Dx: Dx of Exclusion
        
        R/o other causes of anemia before labeling it ACKD
        
        Tx: Fe, EPO, transfusions
        
        Goal: Hgb >10
        
        Hgb <12
  - - - PTH stimulates resorption from bone (PO4 and Ca) but PO4 continues to rise
      - Pt: Asymptomatic
        
        Ca Phos product >55
        
        :warning:risk of calciphylaxis
        
        ulceration of skin (rare because we check labs)
        
        Dx: Labs Ca :glass_of_milk:and PO4
        
        :check: low Ca; high PO4 :checkered_flag:
        
        Tx:
        
        PO4 binders (Sevelamer) reduces PO4 level, for CKD 3-5
        
        Calcimimetics (Cinacalcet) act as Ca and reduce PTH
        
        Also replace Vitamin D & Ca :glass_of_milk:
        (Toy) <2g /day Ca max.
        
        1 more item...
  - - - Tx: Loop and Thiazide
      - not rare for CKD4 w/ some urinary output to be on these drugs, delays onset of ESRD
  - - - Tx: Na Bicarb PO to balance out Bicarb
- - - - Stage 3
        
        Stage 4
        
        ESRD inevitable
        
        GFR: 15-29
        
        Action: prepare for dialysis
        
        Place AV Fistula
        
        Stage 5
        
        GFR: <15
        
        :warning:Action: must have dialysis
        
        ESRD
        
        (Uworld) CV :<3: disease is most common cause of death
        
        GFR: 30-59
        
        Begin to see complications (management for this and all higher stages
        
        (Pretest FM)- Anemia at this stage
        
        refer to nephrology at this stage
      - GFR: 60-89
    - - Action: prevent Progression (true for all stages)
        
        HTN
        
        Proteinuria
        
        Tx: diet low in protein or ACEi
        
        Pt will improve on this tx
        
        Diabetes :candy:
        
        no different than Diabetes tx in gen
        
        Tx: Any Rx (Not METFORMIN) including Insulin
        
        :pencil2:If on insulin or sulfonurea, know hypoglycemia is possible because cleared by kidneys
        
        blood glucose:80-120
        
        1 more item...
        
        Rx Profiles (Toy)
        
        :warning:Avoid
        
        NSAID
        
        Diuretics
        
        Give
        
        ACEi :spades:/ARB
        
        Tx: ACEi or ARB
        
        :pencil2:more aggressive BP control does better than lenient
        
        Goal: <130/<80
        
        Guidelines: <140/90