Section Questions Answers

Size: px

Start display at page:

Download "Section Questions Answers"

Bryan Harvey
5 years ago
Views:

1 Section Questions Answers Guide to CKD Screening and Evaluation -Alec Otteman, MD Delaying Progression - Paul Drawz, MD, MHS, MS 1. Modifiable risk factors for CKD include: a. Diabetes b. Hypertension c. History of AKI d. Frequent NSAID use e. All of the above 2. NKF recommends the following calculator be used to estimate GFR for CKD staging: a. CKD-EPI b. MDRD c. Cockroft-Gault 1. Target blood pressure in non-dialysis CKD with a albuminto-creatinine ratio of <30mg/g should be: a. 120/80mmHg b. 140/90mmHg c. 150/90mmHg d. 130/80mmHg 2. A 55 year-old Caucasian-American man, with a history of type 2 diabetes (15 years), hypertension (3 years) dyslipidemia (5 years) and cardiovascular disease (myocardial infarction 3 years ago). He was recently diagnosed with CKD. His most recent labs reveal an egfr of 45 ml/min/1.73m 2 and an ACR of 38 mg/g. Which of the following should be avoided? E. All of the above Rationale: Diabetes, hypertension, history of AKI, and frequent NSAID use can all damage the kidneys and are risk factors for CKD A.. All of the above Rationale: CKD-EPI is less biased than MDRD particularly at high GFRs and performs equally, or better compared to the MDRD equation in various age groups and all BMI groups (except those with a BMI <20) and is calibrated for the IDMS standardized creatinine available from all labs B. 140/90mmHg Rationale: Comparison of Guideline Recommendations for CKD Blood Pressure Targets among reliable sources, including JAMA2014 and KDIGO2012, contain similar recommendations as less than 140/90 mm Hg in CKD E. A and C Rationale: ACE and ARBs used in combination have been shown to increase adverse events, particularly impaired kidney function and hyperkalemia. NSAIDs

2 A Primary Care Approach to Managing CKD Complications- Sandra Taler, MD Kidney Disease and Heart Failure: Where Medication Efficacy and Safety Collide - Wendy St. Peter, PharmD, FCCP, BCPS a. ACE and ARB in combination b. Daily low-dose aspirin c. NSAIDs d. Statins e. A and C 1. Vitamin D3 is the preferred vitamin D form to achieve normal serum vitamin D levels a. True b. False 2. Which CKD Stage to most of the complications of Kidney Failure start? a. Stage A b. Stage 1 c. Stage 3 d. Stage 5 Which of the following is NOT a reason for diuretic resistance in patients with AHF and CKD: a. Low salt diet b. High urinary protein c. Patient non-adherence d. Braking phenomenon: distal tubule cells hypertrophy over time and become sodium avid. When may NSAIDs be appropriate in patients with AHF and CKD? a. Anytime b. Never have been shown to cause kidney damage and increase CKD progression. Statins are indicated based on KDIGO guidelines and a daily low-dose aspirin is not contraindicated in CKD. True Rationale: Vitamin D3 is less expensive and better absorbed than Vitamin D2 C. Stage 3 Rationale: Stage A is not part of CKD staging. A. Low salt diet Rationale: Low salt diet will improve efficacy of diuretic B. Never Rationale: NSAIDS are always to be avoided due to potential risks of sodium retention, fluid overload, acute kidney injury, and hyperkalemia.

3 c. If the patient rates pain greater than 6 on a scale of d. The patient has some at home. Renal Replacement Therapy: Options and Choices -Marc Weber, MD The Patient Provider Intersection: A CKD Story -Matt Rongstad- Patient and Sara Ruiz, Renal RD 1. Renal replacement therapy should be considered if the patient is experiencing: a. Hyperkalemia b. Metabolic acidosis c. Fluid overload 2. Types of Hemodialysis access include: a. Fistula b. Graft c. Catheter What did Matt (our patient representative) offer as some suggestions to health care professionals providing care to patients with chronic kidney disease? a. Individualize care to patients along the spectrum of very engaged to overwhelmed. b. Be proactive in helping patients weigh risks and benefits of treatment options c. Provide education for prevention strategies of dialysis and CKD progression Which of the following statements accurately describes Matt s experience with the healthcare system: a. Insurance questions were easy to figure out. Rationale: Dialysis can help regulate potassium, acid/base balance and fluid. When the kidneys can no longer balance, renal replacement therapy should be considered Rationale: Fistulas, grafts, and catheters are all established types of hemodialysis access. Rationale: There are ways healthcare professionals can approach patients with CKD to engage them as much as possible and optimize patient-related outcomes. B. He needed to use multiple pharmacies. Rationale: The healthcare system, including pharmacy providers, is

4 The Dialysis Unit: Behind Closed Doors - Andrew Kummer, MD MPH Kidney Transplantation -John Silkensen, MD b. He needed to use multiple pharmacies. c. It was clear to him which doctors were managing which conditions and who to go to for questions. d. His healthcare systems communicated well between each other. Benefits of preserving residual kidney function in dialysis patients include: a. Less dietary restriction b. Better quality of life c. Better survival It is not necessary to avoid nephrotoxins, such as NSAIDs, if patient is on dialysis and has residual kidney function. a. T b. F 1. Which of the following Is not absolute contraindications to renal transplant? a. Active substance abuse b. Active malignancy c. Life expectancy less than 2 years d. GFR <20mL/min 2. A patient with progressive CKD is considering a kidney transplant. Which one of the following statements is correct? tough to navigate for patients. Health care professionals need to consider challenges and complexity of the system itself as care is provided. S. All of the above Rationale: residual kidney function contributes to removal of potential uremic toxins, helps regulate fluid and electrolyte imbalance, and may enhance nutritional status and QOL. B. False As indicated above, residual kidney should be maintained if possible, thus the importance of avoiding nephrotoxins as part of this strategy. D. GFR <20mL/min Rationale: GFR of <20mL/min is when patients should be referred for a consultation about renal transplant. All other answer choices are contraindications to transplant Rationale: All of the statements are

5 Through the Lens of a Primary Care Professional - David Macomber, MD, PhD a. CKD patients can be referred to a transplant center when their GFR is < 20 ml/min/1.73m 2 b. Pre-emptive and live kidney transplants are associated with better graft survival c. Most common cause of kidney transplant loss is death with a functional transplant 1. When should a patient be referred to Nephrology? a. egfr 60 or below b. Presence of proteinuria/ microalbuminuria or microscopic hematuria irrespective of the egfr c. Strong family history 2. The most important nutrition goal/s for patients with CKD include: a. Limit Na, decrease HTN b. Reduce Protein c. Glycemic Control/Weight correct regarding transplant Rationale: According to KDIGO 2012, patients should be referred to Nephrology when egfr is at or below 60, there is a presence of proteinuria/ microalbuminuria or microscopic hematuria irrespective of the egfr, or if the patient has a strong family history. Rationale: There are several important nutrition goals for patients with CKD, including limiting Sodium, decreasing hypertension (if elevated), reduce protein intake, and maintaining a proper weight.

Applying clinical guidelines treating and managing CKD

Applying clinical guidelines treating and managing CKD Develop patient treatment plan according to level of severity. Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012