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Episode 122: Chronic Kidney Disease Overview
Future Dr. Westwood discusses with Dr. Arreaza the evaluation and treatment of CKD before renal replacement therapy. This is a broad overview of CKD.
Written by Daniel Westwood, MSIV, Ross University School of Medicine. Comments and editing by Hector Arreaza, MD.
Definition of CKD:
CKD is defined as abnormal kidney structure or function lasting more than three months with associated health implications. Indicators include albuminuria, urine sediment abnormalities, abnormal renal imaging findings, serum electrolyte or acid-base derangements, and decreased glomerular filtration rate (GFR).
Stages of CKD are based on GFR - CKD1 normal or high >90, CKD2 60-89, CKD3 <60 (3a 45-60), 3b (30-45), CKD4 <30, CKD 5 <15.
CKD can progress to advanced renal failure, end-stage renal disease, and even death; early detection is critical for initiating timely therapeutic interventions, limiting nephrotoxin exposure, preventing further reduction in GFR, and preparing for renal replacement therapy.
Screening guidelines:
How to screen? Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis (especially in diabetes mellitus, hypertension, and a history of cardiovascular disease).
Assessment of a patient with CKD:Markers of Kidney Damage:
Common etiologies of CKD
Management of CKD
Treat reversible causes of CKD
Slow the rate of progression by treating underlying causes:
For patients with proteinuria: Control blood pressure with ACE inhibitors or ARBs and SGLT-2 inhibitors.
Other renal protection methods: Protein Restriction (≤0.8 g/kg/day, increase plant source), Sodium (<5 g/day of table salt), smoking cessation, treating chronic metabolic acidosis w/bicarbonate (slows progression to ESRD), strict glycemic control.
Medications in CKD: For patients with type 2 diabetes who have estimated albuminuria ≥30 mg/day despite an ACE inhibitor (or ARB) and an SGLT2 inhibitor, it is recommended to treat with a nonsteroidal selective mineralocorticoid receptor antagonist (MRA, specifically finerenone), but avoid in those who have serum potassium >4.8 or eGFR<25.
When to Refer to Nephrology:
Per National Kidney Foundation - Nephrology consultation is indicated for patients with:
Per AAFP – consult a nephrologist when there is AKI on CKD, family history of renal disease, RBC casts in the urine, progression of CKD, resistant anemia, refractory hypertension, serum potassium persistently high, mineral and bone disorders, nephrolithiasis, preparation for hemodialysis.
Bottom line: CKD is a major concern for patients with DM and HTN, but it can have multiple causes. Make sure you screen your patients for CKD and start treatment early to prevent end-stage renal disease.
_____________________________________________________
Conclusion: Now we conclude episode number 122, “Chronic Kidney Disease Overview.” Future Dr. Westwood and Dr. Arreaza discussed common signs and symptoms of CKD, and how we can evaluate patients with CKD. Remember to screen your patients with diabetes and hypertension for CKD at least once a year. You may opt to order either a serum creatinine, a urine albumin/creatinine ratio, or just a urinalysis. Once CKD has been diagnosed, your main goal is to prevent end-stage renal disease. Keep in mind at least 3 medications from this episode: ACE inhibitors, SGLT-2 inhibitors, and MRAs.
This week we thank Hector Arreaza and Daniel Westwood. Audio edition by Adrianne Silva.
Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week!
________________________________________________________
5
1111 ratings
Episode 122: Chronic Kidney Disease Overview
Future Dr. Westwood discusses with Dr. Arreaza the evaluation and treatment of CKD before renal replacement therapy. This is a broad overview of CKD.
Written by Daniel Westwood, MSIV, Ross University School of Medicine. Comments and editing by Hector Arreaza, MD.
Definition of CKD:
CKD is defined as abnormal kidney structure or function lasting more than three months with associated health implications. Indicators include albuminuria, urine sediment abnormalities, abnormal renal imaging findings, serum electrolyte or acid-base derangements, and decreased glomerular filtration rate (GFR).
Stages of CKD are based on GFR - CKD1 normal or high >90, CKD2 60-89, CKD3 <60 (3a 45-60), 3b (30-45), CKD4 <30, CKD 5 <15.
CKD can progress to advanced renal failure, end-stage renal disease, and even death; early detection is critical for initiating timely therapeutic interventions, limiting nephrotoxin exposure, preventing further reduction in GFR, and preparing for renal replacement therapy.
Screening guidelines:
How to screen? Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis (especially in diabetes mellitus, hypertension, and a history of cardiovascular disease).
Assessment of a patient with CKD:Markers of Kidney Damage:
Common etiologies of CKD
Management of CKD
Treat reversible causes of CKD
Slow the rate of progression by treating underlying causes:
For patients with proteinuria: Control blood pressure with ACE inhibitors or ARBs and SGLT-2 inhibitors.
Other renal protection methods: Protein Restriction (≤0.8 g/kg/day, increase plant source), Sodium (<5 g/day of table salt), smoking cessation, treating chronic metabolic acidosis w/bicarbonate (slows progression to ESRD), strict glycemic control.
Medications in CKD: For patients with type 2 diabetes who have estimated albuminuria ≥30 mg/day despite an ACE inhibitor (or ARB) and an SGLT2 inhibitor, it is recommended to treat with a nonsteroidal selective mineralocorticoid receptor antagonist (MRA, specifically finerenone), but avoid in those who have serum potassium >4.8 or eGFR<25.
When to Refer to Nephrology:
Per National Kidney Foundation - Nephrology consultation is indicated for patients with:
Per AAFP – consult a nephrologist when there is AKI on CKD, family history of renal disease, RBC casts in the urine, progression of CKD, resistant anemia, refractory hypertension, serum potassium persistently high, mineral and bone disorders, nephrolithiasis, preparation for hemodialysis.
Bottom line: CKD is a major concern for patients with DM and HTN, but it can have multiple causes. Make sure you screen your patients for CKD and start treatment early to prevent end-stage renal disease.
_____________________________________________________
Conclusion: Now we conclude episode number 122, “Chronic Kidney Disease Overview.” Future Dr. Westwood and Dr. Arreaza discussed common signs and symptoms of CKD, and how we can evaluate patients with CKD. Remember to screen your patients with diabetes and hypertension for CKD at least once a year. You may opt to order either a serum creatinine, a urine albumin/creatinine ratio, or just a urinalysis. Once CKD has been diagnosed, your main goal is to prevent end-stage renal disease. Keep in mind at least 3 medications from this episode: ACE inhibitors, SGLT-2 inhibitors, and MRAs.
This week we thank Hector Arreaza and Daniel Westwood. Audio edition by Adrianne Silva.
Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week!
________________________________________________________
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