Ckd

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Dx:

Renal Ultrasound

Urinalysis

UPCR / Spot Urine Protein: Normal < 150mg protein / gcreatinine

UMA: >30mcg alb / mg creat is microalbuminuria

Check PTH, Phos, Check Vitamin D-25

CKD Evaluation


Cause UA Renal US Other Factors
Diabetes Proteinuria >1g/d Normal to Large Kidneys Retinopathy
HTN +/- Proteinuria <600mg/day Small LVH
Renal Vascular Normal Often Asx Kidneys PVD Start on ACEI, watch Cr
Obstruction +/- WBC / Protein Hydronephrosis BPH
Analgesic Nephropathy Usually bland, +/-WBC/Protein Small Echogenic Kidneys Arthritis

Rx:

BP Control <130/80

Check Phos in CKD3b / 4 Check 25-Vitamin D and PTH Drug of Choice AceI/ARB, Check Cr 1 week later.

Phosphate Binders - Calcium Carbonate tums 1250mg or Renagel 800mg ((Auryxia / Velphoro - Iron based Phos binders)) Vitamin D - 35-45, Vit D = Ergoca 50,000u weekly x6-12 mos, then maintenance dose.

Anemia in CKD - Epo, keep Hgb b/w 10 & 11. Iron Def Anemia - functionally Iron deficient in ESRD.

2ndary Hyperparathyroidism - the higher the PTH, the more Ca/Phos mobilized and not excreted in Kidney, deposits in arteries. Rx w/ CKD 3 - Intact PTH >70, Treat w/ Sensipar CKD 4 - Intact PTH >108, Treat w/ Sensipar

Hyperkalemia - Kayexelate 30g weekly

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