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CT Nephrology and Urology Exam
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CT Nephrology and Urology Exam CT Nephrology and Urology Exam CT Nephrology and Urology Exam
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CT Nephrology and Urology ExamThe presence of kidney damage with a GFR >90 would put a patient in what stage of CKD? - Stage 1
The presence of kidney damage with a GFR between 60-89 would put a patient in what stage of CKD? -
Stage 2
A GFR of 30-59 puts a patient in what stage of CKD? - Stage 3
A GFR of 15-29 puts a patient in what stage of CKD? - Stage 4
A GFR <15 puts a patient in what stage of CKD? - Stage 5 (kidney failure)
At what stage of CKD should you prepare your patient for kidney replacement therapy by referring them
to a nephrologist? - Stage 4
You can use the mnemonic A WET BED to help you remember the roles of the kidneys in the body. What
does A WET BED stand for? - Acid-base balance
Water balance
Electrolyte balance
Toxin removal
Blood pressure control
Erythropoietin production
D vitamin metabolism
How do you manage/prevent complications from CKD stage 3-4? Use mnemonic A WET BED to help
answer this question. - - Acid-base balance: use alkali (I.E. sodium bicarb) to maintain normal serum
bicarb (23-29 meq/L)... watch for volume overload
,- Water balance: loop diuretics
- Electrolyte balance: watch out for hyperkalemia and D/C ACE-I or ARB if K is consistently >5.5 (low
potassium diet helpful)
- Toxin removal: stage 4 patients need to be prepared for renal replacement therapy and referred to
nephrologist
- Blood pressure control: BP goal <130/80 (<120 SBP if they can tolerate it), use ACE-I or ARB to reduce
proteinuria
- Erythropoietin production: if AOCD develops (low TIBC, low serum Fe, normal/increased serum ferritin)
check EPO level and use erythropoeitic agents (I.E. IM Ananesp or IM Epogen) with target Hbg 10-11.5
g/dL (normal is around 13). Jesduvroq tablets (daprodustat) approved for patients on dialysis for at least
4 months
- D vitamin metabolism: check vitamin D in these patients and give supplement vitamin D if low (<30
ng/mL). To treat secondary hyperparathyroidism (low calcium, high phosphate), give phosphate binders
like selevamir hydrochloride, calcium acetate or calcium carbonate
What intractable kidney complications require renal replacement therapy? - AWET - intractable acid-
base imbalance (acidosis), intractable water imbalance (volume overload), intractable electrolyte
imbalance especially hyperkalemia, intractable toxins present (toxin/uremic complications like
pericarditis, encephalopathy, seizures)
(note: if one of the above complications presents in the presence of AKI, hemodialysis is the only
treatment option; if they present in the setting of CKD, other options are available because of time to
prepare)
According to the 2023 KDIGO guideline updates for patients with T2DM and CKD, when can a SGLT2-I be
started?
What role does SGLT2-I play for these patients? - - for people with T2DM and an eGFR >20
- these "flozins" reduce the risk of kidney failure and CV disease while lowering blood sugar
According to the 2023 KDIGO guideline updates for patients with T2DM and CKD, this medication
reduces risks of CKD progression and CV events for people with T2DM and residual albuminuria despite
other treatments. It is suggested for patients with T2DM, urine albumin creatine ratio ACR >30 mg/g,
, and normal serum potassium on other standard of care therapies. - ns-MRA (non-steroidal
mineralocorticoid receptor antagonist) finerenone (Kerendia)
What is acute kidney injury? - an abrupt and usually reversible decline in GFR
What potentially life-threatening complications do you want to monitor and treat for in patients with
acute kidney injury? - volume overload, hyperkalemia, acidosis*, uremia
(*According to UpToDate, patients with acute metabolic acidosis, an arterial pH 7.1 to 7.2, and severe
AKI are recommended sodium carbonate therapy, rather than no alkali therapy. We do not typically give
sodium bicarbonate to patients with arterial pH 7.1+ if they do not have severe AKI.)
How do you manage someone who presents with acute kidney injury? - - determine cause (pre-renal,
renal or post-renal) and treat underlying cause (e.g., fluids for hypovolemia, D/C offending medication,
treat post-renal obstruction like if cause is BPH then put in Foley catheter)
Fill in the blanks:
- All patients with hypernatremia have serum ____________.
- _____ ________ helps differentiate renal from non-renal water loss. - hyperosmolality; urine
osmolality
(high urine osmolality suggests non-renal water losses, while low urine osmolality points to renal causes
like DI.)
What are typical findings of hypernatremia? What are early signs of hypernatremia? - - typical: patient is
dehydrated, orthostatic hypotension, oliguria
- early: lethargy, irritability, and weakness
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