CNN-NP flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

CKD definition

Abnormalities of kidney structure or function present for more than 3 months with health implications, including eGFR below 60 mL/min/1.73 m2 or markers of kidney damage such as albuminuria.

KDIGO GFR categories

G1 is 90 or higher, G2 is 60-89, G3a is 45-59, G3b is 30-44, G4 is 15-29, and G5 is below 15 mL/min/1.73 m2.

Albuminuria categories

A1 is less than 30 mg/g, A2 is 30-300 mg/g, and A3 is greater than 300 mg/g on spot urine albumin-to-creatinine ratio; confirm persistent elevation with repeat testing.

AKI KDIGO criteria

Creatinine rise of 0.3 mg/dL or more within 48 hours, or 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

CKD-EPI 2021 equation

Race-free creatinine-based equation used to estimate GFR; it replaced the 2009 equation that included a race coefficient, and cystatin C can be added for confirmation.

Hyperkalemia emergency treatment

Give IV calcium for membrane stabilization when ECG changes are present, then insulin with glucose or albuterol to shift potassium, then remove potassium with diuretics, binders, or dialysis.

CKD metabolic acidosis

Usually a normal-anion-gap acidosis; oral sodium bicarbonate is considered when serum bicarbonate is below 18-22 mEq/L, with monitoring for sodium retention and hypokalemia.

Anemia of CKD

Normocytic normochromic anemia; check iron studies before starting an ESA, and do not initiate ESA when hemoglobin is 10 g/dL or higher.

Peritoneal dialysis peritonitis

Suspected with cloudy effluent, abdominal pain, or fever; diagnosis needs effluent WBC above 100/mm3 with more than 50% neutrophils plus culture, and empiric intraperitoneal antibiotics cover gram-positive and gram-negative organisms.

Hemodialysis adequacy Kt/V

A common target is single-pool Kt/V of at least 1.2 per session for thrice-weekly hemodialysis, equivalent to a urea reduction ratio of at least 65%.

AV fistula rule of 6s

A mature fistula has blood flow above 600 mL/min, diameter above 0.6 cm, and depth below 0.6 cm; maturation usually takes 6-8 weeks before first cannulation.

Dialysis disequilibrium syndrome

Headache, nausea, confusion, seizures, or coma during or after dialysis; prevention uses slower blood flow, shorter initial sessions, and higher sodium dialysate in high-risk patients.

Intradialytic hypotension

Systolic BP fall of 20 mmHg or more or MAP fall of 10 mmHg or more with symptoms during dialysis; assess dry weight, ultrafiltration rate, and antihypertensive timing.

Nephrotic syndrome features

Proteinuria above 3.5 g/day, hypoalbuminemia, edema, and hyperlipidemia; complications include thrombosis, infection, and vitamin D deficiency.

Nephritic syndrome features

Hematuria with dysmorphic RBCs and RBC casts, hypertension, oliguria, and variable proteinuria; post-streptococcal GN shows low C3 after pharyngitis or impetigo.

IgA nephropathy

The most common primary glomerulonephritis worldwide; it presents with episodic gross hematuria after upper respiratory infection, and serum complement is typically normal.

Minimal change disease

The most common nephrotic syndrome in children; light microscopy is normal, electron microscopy shows podocyte foot process effacement, and it usually responds to corticosteroids.

Membranous nephropathy

A common cause of nephrotic syndrome in older adults, often associated with anti-PLA2R antibodies, with a high risk of thrombotic complications.

Rapidly progressive GN

Declining GFR over days to weeks with crescents on biopsy; anti-GBM disease and ANCA-associated vasculitis are key causes requiring urgent nephrology involvement.

Hyponatremia correction limits

Correct no more than 8-10 mEq/L in 24 hours and 18 mEq/L in 48 hours to reduce osmotic demyelination risk; use 3% saline with frequent sodium checks in symptomatic cases.

Hypernatremia correction limit

Correct no more than 10-12 mEq/L per 24 hours to avoid cerebral edema; free water deficit equals total body water times (serum sodium divided by 140 minus 1).

Hypokalemia ECG changes

Flattened T waves, ST depression, and prominent U waves; severe hypokalemia can cause rhabdomyolysis, ileus, and arrhythmias.

Tumor lysis syndrome

Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia; prevention uses hydration and allopurinol or rasburicase for high-risk patients.

Rhabdomyolysis management

CK elevation with myoglobinuria, dark urine, and AKI; treat with aggressive IV fluids and monitor for hyperkalemia and hypocalcemia.

Tacrolimus monitoring

Requires therapeutic drug monitoring; trough goals vary by time post-transplant and rejection risk, and nephrotoxicity plus tremor are common adverse effects.

BK polyomavirus nephropathy

Monitor plasma BK viral load after transplant; sustained high viral load warrants reducing immunosuppression, and biopsy is used to confirm.

CMV prophylaxis after transplant

Valganciclovir prophylaxis for high-risk serostatus, especially donor-positive recipient-negative; active disease presents with fever, leukopenia, and organ involvement.

FENa formula

Fractional excretion of sodium equals (urine sodium times serum creatinine) divided by (serum sodium times urine creatinine), multiplied by 100; below 1% suggests a prerenal state.

RBC casts meaning

Red blood cell casts indicate glomerular bleeding; WBC casts suggest pyelonephritis or interstitial nephritis, and muddy brown casts suggest acute tubular necrosis.

BUN-to-creatinine ratio

A ratio above 20:1 suggests prerenal azotemia or upper GI bleeding; a ratio of 10:1 to 20:1 is typical of normal kidney function.

SGLT2 inhibitors in CKD

Dapagliflozin and empagliflozin reduce CKD progression and heart failure hospitalization in CKD with or without diabetes; eGFR decline of up to 30% after initiation is acceptable.

Nephrotoxic drug avoidance

Avoid NSAIDs in CKD, especially with ACE inhibitors or ARBs and diuretics; they cause afferent arteriolar vasoconstriction and AKI. Metformin is contraindicated when eGFR is below 30.