Chronic Kidney Disease (CKD) Part I – Practice Flashcards

Fifty question-and-answer flashcards covering CKD definition, staging, risk factors, complications, blood-pressure targets, renin–angiotensin drugs, finerenone, diabetes medications, lipid management, and lifestyle modifications.

How does KDIGO define chronic kidney disease (CKD)?

As abnormalities of kidney structure or function that are present for more than 3 months.

For how long must kidney abnormalities persist to meet the definition of CKD?

More than 3 months.

What is considered a normal albumin-to-creatinine ratio (ACR)?

Less than 30 mg/g.

What ACR range defines moderately increased (A2) albuminuria?

30–300 mg/g.

What ACR value indicates severely increased (A3) albuminuria?

Greater than 300 mg/g.

What estimated GFR (eGFR) range corresponds to KDIGO category G1?

≥ 90 mL/min/1.73 m².

What eGFR range corresponds to KDIGO category G2?

60–89 mL/min/1.73 m².

What eGFR range corresponds to KDIGO category G3a?

45–59 mL/min/1.73 m².

What eGFR range corresponds to KDIGO category G3b?

30–44 mL/min/1.73 m².

What eGFR range corresponds to KDIGO category G4?

15–29 mL/min/1.73 m².

What eGFR value defines KDIGO category G5 or kidney failure?

< 15 mL/min/1.73 m².

Approximately what fraction of U.S. adults is estimated to have CKD?

More than 1 in 7 adults (~14 %).

What proportion of adults with diabetes may have CKD?

About 1 in 3.

What proportion of adults with hypertension may have CKD?

About 1 in 5.

Name at least three major risk factors for developing CKD.

Diabetes, hypertension, heart disease, family history of CKD, older age, or obesity.

List four complications for which CKD increases risk.

Cardiovascular disease, electrolyte/acid-base disorders, anemia, bone disease, end-stage kidney disease (ESKD), or death.

What systolic blood pressure (SBP) goal does the 2021 KDIGO guideline recommend for patients with CKD?

Less than 120 mm Hg.

Which antihypertensive drug classes are first-line in CKD patients with albuminuria?

ACE inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs).

At what urine albumin level should an ACEI or ARB be started in a non-dialysis CKD patient?

When urine albumin is > 30 mg per 24 hours (ACR > 30 mg/g).

Besides lowering blood pressure, how do ACEIs/ARBs benefit the kidneys?

They reduce proteinuria and slow CKD progression more effectively than other antihypertensive agents.

Why should the highest tolerated ACEI/ARB dose be used in CKD?

Because renal and cardiovascular protective effects are dose-dependent.

A rise in serum creatinine of what magnitude signals that an ACEI/ARB dose should be reduced or stopped?

An increase greater than 30 % from baseline.

What key electrolyte abnormality must be monitored with ACEIs/ARBs?

Hyperkalemia.

List two absolute contraindications to ACEI/ARB therapy.

Pregnancy and bilateral renal artery stenosis (angioedema is also a contraindication).

What type of drug is finerenone (Kerendia)?

A non-steroidal mineralocorticoid receptor antagonist (MRA).

Which patients should receive finerenone according to KDIGO/ADA?

Those with type 2 diabetes, eGFR > 25 mL/min/1.73 m², normal serum potassium, and albuminuria (ACR > 30 mg/g) despite maximally tolerated ACEI/ARB.

What serum potassium level precludes initiating finerenone?

Serum K ≥ 5.0 mEq/L.

What should be done if a patient’s serum K reaches ≥ 5.5 mEq/L while on finerenone?

Interrupt (hold) finerenone therapy.

How does finerenone affect albuminuria?

It decreases (reduces) albuminuria.

What common electrolyte adverse effect is seen more often with finerenone?

Hyperkalemia.

What is the first-line glucose-lowering drug for T2D patients with CKD and eGFR ≥ 30 mL/min/1.73 m²?

Metformin.

SGLT-2 inhibitors are recommended down to what eGFR for organ protection in CKD?

eGFR ≥ 20 mL/min/1.73 m².

Name three renal or cardiovascular benefits of SGLT-2 inhibitors in CKD.

Slow CKD progression, reduce cardiovascular events, and lower the need for dialysis or transplant (decrease mortality).

Give two common adverse effects of SGLT-2 inhibitors.

Volume depletion and increased risk of mycotic genital infections (others: hypoglycemia, diabetic ketoacidosis).

When are GLP-1 receptor agonists recommended for T2D patients with CKD?

When glycemic targets are not met with metformin and/or an SGLT-2i, or when those drugs cannot be used.

State one kidney-related benefit of GLP-1 receptor agonists.

They slow CKD progression and reduce albuminuria (also reduce cardiovascular events).

What black-box warning is carried by many GLP-1 receptor agonists?

Risk of thyroid C-cell tumors (observed in rats).

Which statin is generally preferred in CKD and why?

Atorvastatin, because it does not require renal dose adjustment.

Name two adverse effects for which patients on statins should be monitored.

Elevated liver function tests (hepatotoxicity) and myopathy/rhabdomyolysis.

List three lifestyle or dietary modifications that may slow CKD progression.

Protein restriction, sodium restriction, smoking cessation, treatment of metabolic acidosis, maintenance of healthy weight, or avoidance of AKI.

What daily protein intake is recommended for many CKD patients?

Approximately 0.8 g/kg of body weight.

What daily sodium restriction is advised in CKD?

Less than 2 g of sodium per day.

What body-weight goal is suggested to reduce CKD progression risk?

Achieving or maintaining a healthy body weight (e.g., BMI < 25 kg/m²).

Why is avoiding acute kidney injury (AKI) important in CKD?

AKI episodes can accelerate loss of kidney function and hasten progression to ESKD.

At roughly what eGFR does KDIGO consider the threshold for diagnosing CKD (if abnormalities persist)?

< 60 mL/min/1.73 m² for more than 3 months or any GFR with markers of kidney damage.

At what eGFR is end-stage renal disease (ESRD) typically defined?

< 15 mL/min/1.73 m² (KDIGO G5).

Why is it important for clinicians to memorize GFR and albuminuria categories?

Because CKD prognosis, staging, and management strategies are based on these categories.

Why is aggressive blood-pressure control recommended in CKD patients?

It reduces cardiovascular events, all-cause mortality, and slows kidney disease progression.

Describe the relationship between CKD and cardiovascular disease (CVD).

CKD markedly increases the risk of CVD events and death; many CKD patients have traditional CVD risk factors.

Which laboratory values should be assessed 1–2 weeks after starting or uptitrating an ACEI/ARB in CKD?

Serum creatinine/eGFR and serum potassium.