High -Yield Internal Medicine Board Exam Pearls by Knowmedge - HTML preview

Creatinine or Potassium

 Both ACEIs and ARBs are the drugs of choice to prevent progression of proteinuric

CKD

 An increase of 20 to 30% of the creatinine level is acceptable

 Just make sure to confirm the creatinine stabilizes and does not continue to increase

 Also a serum potassium of 5.5 mEq/L is acceptable as long as it is stable and as long

as the patient is aware of dietary restrictions

 Serum creatinine and potassium levels should be ordered within one week of increase

in dose of ACEI or ARB

 If a patient has an increase in creatinine from 1.5 to 1.9 (<30% increase) CONTINUE

THE ACEI

41 | P a g e

K N O W M E D G E

 If the same patient has an increase in creatinine from 1.5 to 2.2 (>30% increase) STOP

THE ACEI

Pearl # 6: Anemia in Patients with CKD Should be Treated, but not Overtreated

 Anemia of Chronic Disease can lead to fatigue, left ventricular hypertrophy, and

increased risk of cardiovascular events

 Hemoglobin target for CKD should be between 11 – 12 g/dL NOT to exceed 13g/dL

 Overcorrection of hemoglobin can result in higher risk of stroke, thrombosis, and

hypertension

 Correct all other reversible causes of anemia

Pearl # 7: Phosphate-Containing Bowel Preps Should be Used With Caution

 Sodium phosphate bowel preparations are more convenient than some other preps

(Easier to use)

 However, some studies have suggested that they can cause phosphate nephropathy

leading to AKI or worsening CKD

 Instead use polyethylene glycol for the bowel prep (only downside is the volume that

has to be consumed; Does not cause volume or electrolyte shifts)

Pearl # 8: Patients With Severe CKD Should Avoid Magnesium- or Aluminum-