305 - Chronic Kidney Disease Flashcards
Define CKD
Spectrum of pathophysiological processes related to renal dysfunction and progressive decrease in GFR
ESRD is ___ with accumulation of ___, ___, and ___. When untreated it leads to ___
CKD Toxins Fluids Electrolytes Death
ESRD can be treated by ___ or ___
Dialysis
Kidney transplantation
What are the two variables in KDIGO classification?
GFR
Albuminuria
Give an example for CKD initiating mechanisms factors
Immune complexes deposition in GN
The progressive mechanisms in CKD are the remaining ____ that suffer from ___ and ___. As time passes they will become ___ and ___.
Viable nephrons Hyperfiltration Hypertropia Ineffective Sclerotic
Name 5 risk factors for CKD
SGA Obesity in childhood HTN DM Autoimmune disease
What is the most common AD inherited reason for CKD?
PKD (Polycystic kidney disease)
eGFR can only be measured when there is no change in the ___ level from one day to the other
Cr
Starting from the ___ decade of life, there is a decrease in ___ of ___ per ___
3rd
GFR
1ml/min
year
What are the leading etiological categories of CKD? (5)
Diabetic nephropathy Glomerulonephritis HTN associated CKD AD PKD Cystic & tubulointerstitial nephropathy
The gold standard for assessing glomerular injury is:
24 hours urine collection
Patients in stage 1-2 of CKD are usually ___.
Asymptomatic
In stage 3-4 of CKD patients develop different symptoms such as: (5)
Anemia Fatigue Anorexia Electrolytes imbalance Acid-base problems
In stage 5 of CKD ___ accumulation will lead to different problems and may lead to ____ syndrome
Toxins
Uremic
The main reason for CKD is diabetic ____ usually secondary to ___. The new patients usually present with____
nephropathy
DM2
HTN
New CKD patients usually belong to one of the following 2 groups:
- Focal glomerulosclerosis- subclinical primary glomerulopathy
- Systemic vascular disease- progressive nephrosclerosis and HTN
Uremia is the result of ___ accumulation due to renal ____ failure
toxins
excretory
Uremic syndrome may lead to: (3)
- Anemia
- Malnutrition
- Abnormal metabolism of carbohydrates/fat/protein
CKD leads to water and ___ accumulation with ECF expansion that may lead to glomerular ____ with ___.
Sodium
HTN
Nephropathy
If the CKD patient suffer from edema/HTN restrict ___. If the patient does not improve- add ___. If the patient does not response-____
Salt
Loop diuretics
Dialysis
As renal failure progresses, high ___ metabolic ___may develop due to ___ acid accumulation
AG
acidosis
organic
The basic treatment for fluid electrolytes and acid base disorders is
Salt restriction and loop diuretics
GFR decrease -> Impaired Phosphate secretion->___->increase in FGF23 and ___ increase.
Hyperphosphatemia
PTH
Decreased levels of ionized calcium resulting from suppression of ___ production by ___ and by failing ___
Calcitriol
FGF23
kidney
The changes in the bone turnover start when GFR drops below ___
60 m:/min
The excess of PTH increases high ___ turnover and leads to Osteitis ____
bone
fibrosa cystica
Osteomalacia is the accumulation of ___ material that did not go through ____ as a result of ___ deficiency
Bone
Mineralization
Vitamin D
Dynamic bone disease is:___. it is usually the result of continues depression of ___, chronic ___, or both
A decrease in the volume and mineralization of the bones
PTH
inflammation
Dynamic bone disease may lead to: (3)
Bone pain
Artery calcification
Tumoral calcinosis
Calciphylaxis is the ___ of ___ vessels due to a massive ____ classification
blockage
Blood vessel
vascular
The best treatment for calcium and phosphate metabolism disorders is ____ and includes low ___ diet, monitoring, and ___ binding agents
Protentional
phosphate
phosphate
In calcium and phosphate metabolism disorders keep PTH between - pg/mL
150-300
The leading cause for mortality in CKD patients is ___. Most patients do not reach stage __.
Cardiovascular
5
CKD patients have ___ times more chance to suffer from CV disease
10-200
The specific risk factors for ischemic vascular disease in CKD patients include: (5)
- Anemia
- Hyperphosphatemia
- Hyperparathyroidism
- Increased FGF23
- OSA (Obstructive sleep apnea)
- Systemic inflammation
What may be the reason for hypotension in CKD patients?
Salt wasting syndrome or decreased LV function
What are the common CV disease CKD patients may suffer from? (4)
Ischemic vascular disease
CHF
HTN
LVH
In CKD + DM or proteinuria> 1 g/24h, what is the recommended BP?
130/80
Which drugs are recommended for BP treatment in CKD patients? (2)
ARBs and ACEi
What are the S/E of ARB and ACEi in CKD patients? (2)
- AKI
2. Hyperkalemia
Pericardial disease is a definitive indication for emergency ___
dialysis
Normocytic normochromic anemia may appear in CKD stage ___, and will always present in stage ___
3
4
The reason for anemia in CKD patients is: (5)
- Decreased EPO production
- Decreased iron utilization
- Hyperparathyroidism
- B12/folic acid deficiency
- Aluminum toxicity
Treat CKD anemia with: (3)
- EPO
- Iron
- B12/folic acid
CKD patients may encounter abnormal hemostasis, treatment include: (5)
Desmopressin Cryoprecipitate Estrogen IV Blood transfusion EPO
General treatment for hemostasis disorders in CKD patients include:
Heparin
Why NOAC is not recommended in CKD patients?
Renal excretion
In which stage of CKD will neuromuscular disorders start?
3
What is uremic fetor
Urine like odor on the breath, from the break down of urea to ammonia in saliva
What is the GFR of each stage of CKD?
- Normal or high >=90
- Mildly decreased =60-89
3a. Mildly to moderately decreased= 45-59
3b. Moderately to severely decreased - Severely decreased 15-29
- Kidney failure <15
