LT Julie Taylor-Cure Bureau of Prisons FMC Devens


LT Julie Taylor-Cure Bureau of Prisons FMC Devens
LT Julie Taylor-Cure
Bureau of Prisons
FMC Devens
Review what chronic kidney disease is
Discuss how to recognize chronic kidney
Review tools to delay onset or progression of
kidney disease
Loss of kidney function over time
Losing ability to remove waste products from
the body
They don’t just make urine
Chronic Kidney Disease.
In the clinical setting, the creatinine and the
glomerular filtration rate (GFR) are used
 Creatinine is a waste product that is filtered but
not reabsorbed which is why it is monitored
and is a good measure of how the kidney is
 Glomerular filtration rate (GFR) is the best
overall index of kidney function, it’s a
calculation based on age, gender and creatinine
Protein in the urine
Urinalysis can only detect if the protein is
above 300mg
A specific test called urine microalbumin can
measure small amount of protein, below the
300mg level
If a person that has a microalbumin between
30-300, that is a sensitive indicator for kidney
3% 2%
Cystic kidney
Other urologic
US Renal Data system. 4th Quarter
The main causes of CKD are diabetes and
These are lifestyle associated diseases
Diet and exercise are crucial
My Plate. US Department of
Tight control over diabetes and blood pressure
Blood pressure less than 140/90
Hemoglobin A1c under 7.0
Quit smoking!
Know your medications
Educate patients to avoid non-steroidal antiinflammatories (like ibuprofen, naproxen, aspirin)
 Certain antibiotics are worse for CKD than other
 Contrast dye for CT/MRI
 Decongestants with pseudoephedrine
 Antacids and laxatives with magnesium,
phosphorus and aluminum
 Alkaselzer products (baking soda products for
ACE inhibitors
Have been show to delay chronic kidney disease in
persons with microalbuminuria
Though they can actually worsen chronic kidney
disease above stage III
1st line thiazide diuretic for blood pressure are not
recommended if the creatinine is above 2.5
 Switch patient to a loop diuretic
1st line oral medication in the treatment of Diabetes
Mellitus Type II
Not recommended if creatinine is above 1.5
Common oral medication for treatment of DM-II
Increased risk of hypoglycemia in patients with CKD
III and above
Consider switching to glipizide (no dose adjustment
Premature death from all causes and from
cardiovascular disease is higher in adults with
CKD than in adults without CKD. In fact,
individuals with CKD are 16 to 40 times more
likely to die than to reach ESRD.
Very expensive to patients and to the
healthcare system
National Kidney Foundation.
US Renal Data System. USRDS 2014 Annual Data Report: Atlas of Chronic Kidney
Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National
Institutes of Health, National Institute of Diabetes and Digestive and Kidney
Diseases; 2014.
JNC 8 Hypertension Guidelines.
Guidelines for Drug Dosing Regimens in Chronic Kidney Disease. Medscape
medical news. Barclay, Laurie. Am Fam Physician. 2007;75:1487-1496.
Narva AS, Briggs M, Jordan R, Pavkov ME, Burrows NR, Williams DE.
Toward a more collaborative federal response to chronic kidney disease.[PDF406KB] Adv Chronic Kidney Dis. 2010;17(3):282−288.
Albright A, Burrows NR, Jordan R, Williams DE. The Kidney Disease
Initiative and the Division of Diabetes Translation at the Centers for Disease
Control and Prevention. Am J Kidney Dis. 2009;53(3 Suppl 3):S121–5.