Chronic Kidney Disease

# Chronic Kidney Disease
Defined by CKD <60 (Stage II) for 3 months or proteinuria (or evidence) for 3 months

A.  Progression/proteinuria: Slowly progressive. Cr **. Proteinuria increased to ** compared to ***, remains < 1g/g. Continue RAAS blockade.
P/Cr: <150 mg/g (<15mg/mmol), severe >500
Alb/Cr: <30 mg/g (<3mg/mmol), severe >300
Cr >2.5: hold RAAS

B.  Hypertension:  SBP goal <140 w/o proteinuria, SBP<130/80 + proteinuria use ACEi, ARB, Dilt/Verapamil, thiazide if GFR>30, if <30 need Lasix, (Spironolactone, Aliskiren). S/E: hyperkalemia, angioedema, and teratogenicity

C.  Bone/mineral metabolism: Ca, Phos, PTH, 25-OH-VitD (longer half-life). Calcium repletion if……Phosphate binders if >4.5 in CKD3b-5.  When 25OH vitamin D levels are <10ng/ml, start with ergocalciferol 50,000IU weekly for 6-8 weeks, then switch to cholecalciferol 800-1000IU daily. Calcitriol if ……….

D.  Acid/base and electrolytes:  derangements.

E.  Erythropoiesis:  screening begins with Stage 3a. Erythropoiesis-stimulating agents (ESA) for Hb <10. Anemia 2/2 is dx of exclusion

F.  Volume:  Euvolemic.

G.  Cardioprotection:  Continue aspirin and statin.