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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
Q

Nomograms are useful only in

A

Steady State Conditions - Chronic Renal Insufficiency

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18
Q

Most life threatening electrolyte abnormality

A

Severe Hypokalemia

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19
Q

What do ACEi’s and ARB’s reduce that make them superior to other anti-HTN in CKD

A

Glomerular capillary pressure and Proteinuria

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19
Q

First abnormality in Diabetic Nephropathy

A

Microalbuminuria

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20
Q

Symptoms of chronic kidney disease

A

Most commonly asymptomatic

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20
Q

Why Anemia in advanced renal failure

A

Diminished EPO production

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21
Q

While creatinine conc increases as a function of GFR, BUN increases as function of

A

GFR and Urine Flow Rate

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22
Q

What has been shown to preserve renal fxn in both proteinuric and non-proteinuric renal diseases

A

Maintenance of normal BP with anti-hypertensives and dietary Na restriction

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23
Q

Anemia in CKD occurs at what GFR

A

30% of normal

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24
Q

Main thing to control in chronic kidney disease

A

BP

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26
Q

Most common cause of Advanced Kidney Disease

A

DM

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27
Q

What increases after 5/6 nephrectomy

A

SNGFR, Glomerular Pressure, Glomerular Volume, Urine Albumin –> Sclerosis

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28
Q

4 common symptoms of chronic kidney disease

A

Peripheral Neuropathy, Bone changes (high PTH), Small echogenic kidneys, Waxy casts

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28
Q

Result of increased TGF-beta by RAAS activation

A

Fibrosis

30
Q

How does protein restriction affect GFR

A

Protein intake normally raises it transiently

31
Q

Greater than 50% loss of nephron mass results in dose dependent increase in risk of

A

HTN, Protein (focal segmental glomerulosclerosis)

32
Q

CKD is best throught of as

A

Loss of functioning nephrons

33
Q

How does GFR affect 1a-Hydroxylase and 1,25(OH)2

A

Decr GFR -> Decr 1a-Hydroxylase -> Decr 1,25(OH)2

34
Q

Can nomograms be used for Chronic Renal Insufficiency

A

Yes, not acute

34
Q

Type of Anemia in CKD (PBS findings)

A

Normocytic, Normochromic with Burr Cells

35
Q

Pressure Natriuresis curve for Aldosterone-Stimulated Kidneys

A

Very decreased slope, not shifted right

35
Q

Can Nomograms be used for Acute Renal Failure

A

No, must be steady state

36
Q

Histology of Diabetic Nephropathy

A

Increased mesangial matrix, Glomerular Collapse, Glomerulosclerosis

37
Q

Pressure Natriuresis curve for Loss of Renal Mass

A

Significantly decreased slope, not shifted right

37
Q

GI effects of Renal Insufficiency

A

Decreased appetite, Nausea (gastroparesis, happens on empty stomach), Vomitting –> Net result is protein calorie malnutrition

39
Q

Chronic Renal Insufficiency equals a reduce

A

number of normally functioning nephrons

40
Q

Stage 2 CDK

A

60-89

42
Q

What decreases after 5/6 nephrectomy

A

Number of Glomerular Epithelial cells, Kf

44
Q

Prevalance of Nephropathy in DM

A

30-40% of type 1, unknown in type 2

45
Q

Why Fasting Hypoglycemia in advanced renal failure

A

Decreased Insulin degradation, Decreased gluconeogenesis by kidney

46
Q

Which GFR formula is most commonly reported in hospital labs

A

MDRD equation

48
Q

Pros and Cons of Protein Restriction

A

Reduces workload of glomerulus, but poor adherence and promotes malnutrition

49
Q

Allergic Interstitial Nephritis is characterized by

A

Presence of Sterile Pyuria

50
Q

Late Chronic Renal Failure is associated with what CV changes

A

Marked Anemia, Volume Overload -> CHF, Pericarditis

52
Q

Volume status in essential HTN in advanced CKD patients

A

Normal volume status until GFR becomes depressed

53
Q

Renal response to nephron loss

A

Compensatory Glomerular Hypertophy and Hyperfiltration

54
Q

What causes low Vit D in renal insufficiency

A

Decr GFR and HyperPhosphatemia -> Decr 1a-Hydroxylase -> Decr 1,25(OH)2

56
Q

What is an echogenic kidney

A

White on US - likely chronic

57
Q

Will serum creatinine over or under-estimate true GFR

A

OVER

58
Q

__ in remaining nephrons may mask the presence of nephron loss

A

Increased filtration

59
Q

Term used to describe signs and symptoms associated with advanced renal failure

A

Uremia

60
Q

What percent of patients with Advanced CKD have HTN

A

85-90%

61
Q

Nervous system changes: More severe failure can lead to

A

Overt encephalopathy, often manifested by Asterixis; Peripheral Neuropathy

62
Q

In proteinuric diseases, which class of drugs has been shown to have a selective advantage over other anti-HTN

A

ACEi’s and ARB’s

63
Q

Last electrolyte for which homeostasis is lost

A

K

65
Q

3 Factors suggesting Glomerular over Tubular

A

2+ or greater proteinuria; RBC casts; Gsp > 1.015

66
Q

Diuretic used for advanced kidney disease

A

Loop

67
Q

Adverse effects of Hyperphosphatemia

A

(1) Inhibit 1a-Hydroxylase; (2) Enhance PTH directly; (3) Metastatic Calcification

69
Q

What percent of HTN in advanced CKD patients is volume driven

A

80%

70
Q

3 Consequences in Trade-Off Hypothesis

A

Secondary HyperParathyroidism (Ca, PO4), Hypertension (Na), Hyperaldosteronism and HTN (K)

71
Q

RBC Casts =

A

Glomerular etiology

73
Q

What is Uremia

A

Term used to describe signs and symptoms associated with advanced renal failure

75
Q

Which anti-HTN drugs reduce glomerular capillary pressure

A

ACEi’s and ARB’s

77
Q

When are creatinine clearance and nomograms useless

A

When Creatinine is changing

78
Q

Stage 3 CKD

A

GFR 30-59

79
Q

Early Chronic Renal Failure is associated with what cardiac changes

A

HTN –> LV Hypertrophy

80
Q

Which organ systems are affected by chronic renal insufficiency

A

Virtually all

80
Q

Maintenance of normal BP has shown to preserve renal fxn in which class of renal diseases

A

Both Proteinuric and Non-Proteinuric

81
Q

2 main signs of chronic kidney disease

A

Small, shrunken kidneys; Waxy casts

82
Q

What causes >10:1 BUN:Creatine ratio

A

Pre-renal Azotemia, Dehydration -> Decr urine flow rate -> Decr excretion of Urea -> Disproportionate increase in BUN

83
Q

Adverse effects of RAAS other than Na retention and systemic vasoconstriction

A

Glomerular HTN (efferent art constriction), Increased release of TGF-beta –> Fibrosis

85
Q

Stage 4 CKD

A

GFR 15-29

86
Q

Do damaged nephrons function appropriately?

A

Generally, yes - therefore, loss of renal homeostasis is due to decreased numer

88
Q

How does GFR affect Ca absorption in gut

A

Decr GFR -> Decr 1a-Hydroxylase -> Decr 1,25(OH)2 -> Decr Ca absorption

89
Q

Patients with __ should be in the highest risk group fro CVD, irrespective of ___

A

CDK, irrespective of traditional CVD risk factors

90
Q

Uremia is 100% fatal unless

A

Reversible factors found that can improve GFR; Renal replacement tx

91
Q

One of the first things that will increase in blood with renal insufficiency

A

Phosphorus

92
Q

Best Anti-HTN’s to use in CKD

A

ACEi’s and ARB’s

93
Q

Which anti-HTN decrease proteinuria more than others

A

ACEi’s and ARB’s

Renal (31 decks)

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