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Renal > 05.16 - CKD (Huch) - PP, No reading > Flashcards

05.16 - CKD (Huch) - PP, No reading Flashcards

1
Q

What % loss of nephron mass results in increase risk of HTN, Proteinuria

A

50%

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2
Q

Creatinine has to be ___ to use to estimate GFR

A

Stable, steady state

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2
Q

Stage 5 CKD

A

GFR <15 or Dialysis

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3
Q

Renal H+ secretion into urine is synonymous with

A

Addition of new bicarb into blood

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3
Q

Acid Base dysfunction in CKD and why

A

Decr ability to excrete acid -> Decr new bicarb -> Metabolic Acidosis with Normal AG

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3
Q

Diuretic used for BP

A

Thiazide

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4
Q

Urine output in CDK

A

Still have urine until very end (surprisingly)

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4
Q

Most important element to determine glomerular vs tubular disease

A

Urinalysis

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5
Q

Net result of GI effects of Renal Insufficiency

A

Protein Calorie Malnutrition

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6
Q

ACEi’s and ARB’s reduce systemic pressure and are unique in

A

reducing glomerular capillary pressure

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7
Q

Nervous system changes in early to moderate renal insufficiency

A

Intellectual function, particularly concentrating

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8
Q

3(4) Factors suggesting Tubular etiology over Glomerular

A

Absence of heavy proteinuira; Inability to dilute or concentrate urine (Gsp 1.010); Hyperkalemia and Metabolic Acidosis out of proportion to degree of renal insufficiency

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8
Q

How does muscle mass affect Screatinine readings

A

If higher muscle mass, serum creatinine will normally be higher and will under-estimate GFR

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8
Q

Common manifestation of overt encephalopathy

A

Asterixis

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9
Q

Pressure Natriuresis curve for Essential HTN

A

Shifted Right and Decreased Slope

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11
Q

Most common cause of eosinophils in urine

A

Allergic Interstitial Nephritis

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12
Q

Endocrine abnormalities with advanced renal failure

A

Fasting Hypoglycemia

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14
Q

Does CKD progress even if initial injuring stimulus is removed?

A

Yes

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14
Q

Signs and Symptoms of Uremia

A

Nausea, Vomiting, Anorexia, Confusion, Encephalopathy, The Flap

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14
Q

Early changes in Diabetic Nephropathy

A

Hyperfiltration resulting in glomerular capillary HTN and Glomerular Hypertrophy

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15
Q

3 Disease Dependent mechanisms of Nephron Injury

A

Vascular, Glomerular, Tubular

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16
Q

HTN promotes nephron loss in which types of renal diseases

A

All: Tubular, Glomerular, Vascular

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17
Q

Primary route for excretion of PO4

A

Kidney

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17
Q

When do you not give Epo

A

Iron deficient

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18
Nomograms are useful only in
Steady State Conditions - Chronic Renal Insufficiency
18
Most life threatening electrolyte abnormality
Severe Hypokalemia
19
What do ACEi's and ARB's reduce that make them superior to other anti-HTN in CKD
Glomerular capillary pressure and Proteinuria
19
First abnormality in Diabetic Nephropathy
Microalbuminuria
20
Symptoms of chronic kidney disease
Most commonly asymptomatic
20
Why Anemia in advanced renal failure
Diminished EPO production
21
While creatinine conc increases as a function of GFR, BUN increases as function of
GFR and Urine Flow Rate
22
What has been shown to preserve renal fxn in both proteinuric and non-proteinuric renal diseases
Maintenance of normal BP with anti-hypertensives and dietary Na restriction
23
Anemia in CKD occurs at what GFR
30% of normal
24
Main thing to control in chronic kidney disease
BP
26
Most common cause of Advanced Kidney Disease
DM
27
What increases after 5/6 nephrectomy
SNGFR, Glomerular Pressure, Glomerular Volume, Urine Albumin --\> Sclerosis
28
4 common symptoms of chronic kidney disease
Peripheral Neuropathy, Bone changes (high PTH), Small echogenic kidneys, Waxy casts
28
Result of increased TGF-beta by RAAS activation
Fibrosis
30
How does protein restriction affect GFR
Protein intake normally raises it transiently
31
Greater than 50% loss of nephron mass results in dose dependent increase in risk of
HTN, Protein (focal segmental glomerulosclerosis)
32
CKD is best throught of as
Loss of functioning nephrons
33
How does GFR affect 1a-Hydroxylase and 1,25(OH)2
Decr GFR -\> Decr 1a-Hydroxylase -\> Decr 1,25(OH)2
34
Can nomograms be used for Chronic Renal Insufficiency
Yes, not acute
34
Type of Anemia in CKD (PBS findings)
Normocytic, Normochromic with Burr Cells
35
Pressure Natriuresis curve for Aldosterone-Stimulated Kidneys
Very decreased slope, not shifted right
35
Can Nomograms be used for Acute Renal Failure
No, must be steady state
36
Histology of Diabetic Nephropathy
Increased mesangial matrix, Glomerular Collapse, Glomerulosclerosis
37
Pressure Natriuresis curve for Loss of Renal Mass
Significantly decreased slope, not shifted right
37
GI effects of Renal Insufficiency
Decreased appetite, Nausea (gastroparesis, happens on empty stomach), Vomitting --\> Net result is protein calorie malnutrition
39
Chronic Renal Insufficiency equals a reduce
number of normally functioning nephrons
40
Stage 2 CDK
60-89
42
What decreases after 5/6 nephrectomy
Number of Glomerular Epithelial cells, Kf
44
Prevalance of Nephropathy in DM
30-40% of type 1, unknown in type 2
45
Why Fasting Hypoglycemia in advanced renal failure
Decreased Insulin degradation, Decreased gluconeogenesis by kidney
46
Which GFR formula is most commonly reported in hospital labs
MDRD equation
48
Pros and Cons of Protein Restriction
Reduces workload of glomerulus, but poor adherence and promotes malnutrition
49
Allergic Interstitial Nephritis is characterized by
Presence of Sterile Pyuria
50
Late Chronic Renal Failure is associated with what CV changes
Marked Anemia, Volume Overload -\> CHF, Pericarditis
52
Volume status in essential HTN in advanced CKD patients
Normal volume status until GFR becomes depressed
53
Renal response to nephron loss
Compensatory Glomerular Hypertophy and Hyperfiltration
54
What causes low Vit D in renal insufficiency
Decr GFR and HyperPhosphatemia -\> Decr 1a-Hydroxylase -\> Decr 1,25(OH)2
56
What is an echogenic kidney
White on US - likely chronic
57
Will serum creatinine over or under-estimate true GFR
OVER
58
\_\_ in remaining nephrons may mask the presence of nephron loss
Increased filtration
59
Term used to describe signs and symptoms associated with advanced renal failure
Uremia
60
What percent of patients with Advanced CKD have HTN
85-90%
61
Nervous system changes: More severe failure can lead to
Overt encephalopathy, often manifested by Asterixis; Peripheral Neuropathy
62
In proteinuric diseases, which class of drugs has been shown to have a selective advantage over other anti-HTN
ACEi's and ARB's
63
Last electrolyte for which homeostasis is lost
K
65
3 Factors suggesting Glomerular over Tubular
2+ or greater proteinuria; RBC casts; Gsp \> 1.015
66
Diuretic used for advanced kidney disease
Loop
67
Adverse effects of Hyperphosphatemia
(1) Inhibit 1a-Hydroxylase; (2) Enhance PTH directly; (3) Metastatic Calcification
69
What percent of HTN in advanced CKD patients is volume driven
80%
70
3 Consequences in Trade-Off Hypothesis
Secondary HyperParathyroidism (Ca, PO4), Hypertension (Na), Hyperaldosteronism and HTN (K)
71
RBC Casts =
Glomerular etiology
73
What is Uremia
Term used to describe signs and symptoms associated with advanced renal failure
75
Which anti-HTN drugs reduce glomerular capillary pressure
ACEi's and ARB's
77
When are creatinine clearance and nomograms useless
When Creatinine is changing
78
Stage 3 CKD
GFR 30-59
79
Early Chronic Renal Failure is associated with what cardiac changes
HTN --\> LV Hypertrophy
80
Which organ systems are affected by chronic renal insufficiency
Virtually all
80
Maintenance of normal BP has shown to preserve renal fxn in which class of renal diseases
Both Proteinuric and Non-Proteinuric
81
2 main signs of chronic kidney disease
Small, shrunken kidneys; Waxy casts
82
What causes \>10:1 BUN:Creatine ratio
Pre-renal Azotemia, Dehydration -\> Decr urine flow rate -\> Decr excretion of Urea -\> Disproportionate increase in BUN
83
Adverse effects of RAAS other than Na retention and systemic vasoconstriction
Glomerular HTN (efferent art constriction), Increased release of TGF-beta --\> Fibrosis
85
Stage 4 CKD
GFR 15-29
86
Do damaged nephrons function appropriately?
Generally, yes - therefore, loss of renal homeostasis is due to decreased numer
88
How does GFR affect Ca absorption in gut
Decr GFR -\> Decr 1a-Hydroxylase -\> Decr 1,25(OH)2 -\> Decr Ca absorption
89
Patients with __ should be in the highest risk group fro CVD, irrespective of \_\_\_
CDK, irrespective of traditional CVD risk factors
90
Uremia is 100% fatal unless
Reversible factors found that can improve GFR; Renal replacement tx
91
One of the first things that will increase in blood with renal insufficiency
Phosphorus
92
Best Anti-HTN's to use in CKD
ACEi's and ARB's
93
Which anti-HTN decrease proteinuria more than others
ACEi's and ARB's

Renal (31 decks)

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