video thumbnail

Chronic Kidney Disease (CKD) - Part 2

Duration: 39:34

Write A New Comment




Nov 23 2020, 7:51 pm

If I have a pt who requires treatment for HTN and they look like they may progress to DKD at some point (i.e. uncontrolled diabetes), would it be a good choice to just start them right out on Losartan?  I know amlodipine is 1st line therapy in many patients.  Thanks for your thoughts and for a great lecture.




Nov 22 2020, 9:19 pm

Hello Sarah, 

Great question. Yes, start any patient with DM and HTN on an ACEI (losartan) or ARB, even if they are at Stage 1, 2 or 3. After starting the medication on the lower dose, check potassium level 1 week later to make sure they are not hyperkalemic and their Cr is not elevated too much. You will see a Cr rise of at leat 0.3mg/dL or slightly more (but ideally not >1mg/dL) after starting ACEI or ARB. The ACEI/ARB should show improvement in proteinuria by 1 month and ideally you can go up on the ACEI/ARB dose to get the proteinuria goal to be 0.5g to 1gm daily on a 24hr urine protein test. Starting ACEI/ARB at Stage 4b or 5 disease is generally not recommended becasue it would mean that the patients have already progressed further in kidney failure where dialysis will be imminent unless patients have a kidney transplant. If the patient was started on ACEI/AR during Stage 3 and are now at Stage 5, then I will continue that ACEI/ARB until I notice worsening hyperkalemia. 

For diabetic patient, the latest recommendations are also to try a SGLT2 inhibitor if the patient continues to have uncontrolled glycemia and/or proteinuria and  if patients also have heart disease (heart failure, CAD, CVA, etc). SGLT2 inhibitors work great and have relatviely low side effects and research studies have shown that they are cardioprotective. 

A good reference from KDIGO:



Nov 23 2020, 6:35 pm

Thanks much!




Sep 16 2020, 3:29 am




Sep 16 2020, 4:27 pm


Hello Achin, 

great questions, we plan to have a lecture on management of them in the future. Please refer to KDIGO guidelines:   (re: PTH and phosphatemia after page 16,17).

In general, we recommend keeping serum phosphatase around 3-5.5mg/dl using phosphate binders (sevelemer carbonate and calcium acetate). Note, that if patients have high coronary artery disease or hypercalcemia, then avoid phosphate binder with calcium (so instead give sevelemer). If any patient has history of malabsorption (i.e. cystic fibrosis, ileostomy, gastric surgery/short bowel syndrome, inflammatory bowel disease), then give the phosphate binder with calcium. Also, patients need to eat low phosphate diet (ie. <800mg). 

For hyperparathyroid, the first step is to confirm if it is PRIMARY or SECONDARY related. Check serum calcium, ionized calcium, serum Vitamin D 250H, intact PTH and rPTH, serum phosphorus. If it is primary hyperparathyroid, then the treatment is removal of the parathyroid (ex. surgery). If it is secondary hyperparathyroid. Secondary hyperparathyoid needs to be treated because it causes bone-mineral dysfunction. For the PTH goals, please refer to guidelines posted   Treatment iinvolves correcting the hyperphospatemia and/or vitaminD deficiency. Then, if patient continues to have secondary hyperparathyroism, treat with sensipar. Caution use of Cinacalcet if serum calcium is low (i.e <7).

Ex of medications--

•Active vitamin D/ Vitamin D analog (active vitamin D): Calcitriol, Doxercalciferol, Paricalcitol

      Side effects: hypercalcemia, hyperphosphatemia

•Calcium-sensing Receptor Agonist (Etelcalcetide - IV, Cinacalcet - PO)

       Side effects: hypocalcemia, GI symptoms


Parathyroidectomy recommended in severe refractory secondary hyperparathyroidism

Dr. Anam Tariq continues the CKD discussion. In this part she discusses the diabetic kidney disease (DKD) and the following topics:

  • DKD definition
  • Type I diabetes mellitus and DKD
  • Type II diabetes mellitus and DKD
  • Diabetic damage to small blood vessels
  • Modifiable and non-modifiable risk factors for DKD
  • Clinical presentation of DKD
  • Stages of DKD
  • Natural history of DKD
  • Treatment of DKD
  • Factors that affect the CKD progression
  • Dose adjustment strategies


In this video we will learn about :

1. Diabetic kidney disease (DKD). 

2. Pathophysiology.

3. Modifiable and non modifiable risk factors

4. Diagnosis of DKD.

5. Sages of DKD.

6. Treatment.

7. Factors that affect CKD progression.

8. Blood pressure control in CKD.

9. Dose adjustment in CKD.

Following answers are created by ChatGPT. Occasionally the answer may be harmful, incorrect, false, misleading, incomplete, or limited in knowledge of world. Please contact your doctor for all healthcare decisions. Also, double check the answer provided by the AI below.

Please login to access this content.

Don't have an account?

Start Your Free trial

No credit card information needed.


Dr. Anam Tariq

Dr. Anam Tariq

Internist, Nephrologist

Dr. Anam Tariq is a nephrologist in Baltimore, Maryland. She received her medical degree from Edward Via Virginia College of Osteopathic Medicine and has been in practice between 11-20 years. Dr. Anam Tariq accepts Blue Cross, United Healthcare. She has also traveled to Honduras and Dominican Republic on medical relief trips, delivering medications to free health clinics, performing first aid, serving as first responder and teaching hygiene practices. Her volunteer work has been recognized nationally and she has been awarded the Presidential award from George W. Bush for the recognition of devoted service through national organizations, such as the Veterans Affairs and the American Osteopathic Association.

Renal System

Related Videos