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Harrison's Principles of Internal Medicine 20 > 305 - Chronic Kidney Disease > Flashcards

305 - Chronic Kidney Disease Flashcards

1
Q

Define CKD

A

Spectrum of pathophysiological processes related to renal dysfunction and progressive decrease in GFR

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2
Q

ESRD is ___ with accumulation of ___, ___, and ___. When untreated it leads to ___

A 
CKD
Toxins
Fluids
Electrolytes
Death
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3
Q

ESRD can be treated by ___ or ___

A

Dialysis

Kidney transplantation

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4
Q

What are the two variables in KDIGO classification?

A

GFR

Albuminuria

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5
Q

Give an example for CKD initiating mechanisms factors

A

Immune complexes deposition in GN

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6
Q

The progressive mechanisms in CKD are the remaining ____ that suffer from ___ and ___. As time passes they will become ___ and ___.

A 
Viable nephrons 
Hyperfiltration 
Hypertropia 
Ineffective 
Sclerotic
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7
Q

Name 5 risk factors for CKD

A 
SGA
Obesity in childhood
HTN
DM
Autoimmune disease
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8
Q

What is the most common AD inherited reason for CKD?

A

PKD (Polycystic kidney disease)

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9
Q

eGFR can only be measured when there is no change in the ___ level from one day to the other

A

Cr

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10
Q

Starting from the ___ decade of life, there is a decrease in ___ of ___ per ___

A

3rd
GFR
1ml/min
year

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11
Q

What are the leading etiological categories of CKD? (5)

A 
Diabetic nephropathy
Glomerulonephritis
HTN associated CKD
AD PKD
Cystic & tubulointerstitial nephropathy
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12
Q

The gold standard for assessing glomerular injury is:

A

24 hours urine collection

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13
Q

Patients in stage 1-2 of CKD are usually ___.

A

Asymptomatic

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14
Q

In stage 3-4 of CKD patients develop different symptoms such as: (5)

A 
Anemia
Fatigue
Anorexia
Electrolytes imbalance
Acid-base problems
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15
Q

In stage 5 of CKD ___ accumulation will lead to different problems and may lead to ____ syndrome

A

Toxins

Uremic

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16
Q

The main reason for CKD is diabetic ____ usually secondary to ___. The new patients usually present with____

A

nephropathy
DM2
HTN

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17
Q

New CKD patients usually belong to one of the following 2 groups:

A
  1. Focal glomerulosclerosis- subclinical primary glomerulopathy
  2. Systemic vascular disease- progressive nephrosclerosis and HTN
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18
Q

Uremia is the result of ___ accumulation due to renal ____ failure

A

toxins

excretory

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19
Q

Uremic syndrome may lead to: (3)

A
  1. Anemia
  2. Malnutrition
  3. Abnormal metabolism of carbohydrates/fat/protein
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20
Q

CKD leads to water and ___ accumulation with ECF expansion that may lead to glomerular ____ with ___.

A

Sodium
HTN
Nephropathy

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21
Q

If the CKD patient suffer from edema/HTN restrict ___. If the patient does not improve- add ___. If the patient does not response-____

A

Salt
Loop diuretics
Dialysis

22
Q

As renal failure progresses, high ___ metabolic ___may develop due to ___ acid accumulation

A

AG
acidosis
organic

23
Q

The basic treatment for fluid electrolytes and acid base disorders is

A

Salt restriction and loop diuretics

24
Q

GFR decrease -> Impaired Phosphate secretion->___->increase in FGF23 and ___ increase.

A

Hyperphosphatemia

PTH

25
Q

Decreased levels of ionized calcium resulting from suppression of ___ production by ___ and by failing ___

A

Calcitriol
FGF23
kidney

26
Q

The changes in the bone turnover start when GFR drops below ___

A

60 m:/min

27
Q

The excess of PTH increases high ___ turnover and leads to Osteitis ____

A

bone

fibrosa cystica

28
Q

Osteomalacia is the accumulation of ___ material that did not go through ____ as a result of ___ deficiency

A

Bone
Mineralization
Vitamin D

29
Q

Dynamic bone disease is:___. it is usually the result of continues depression of ___, chronic ___, or both

A

A decrease in the volume and mineralization of the bones

PTH

inflammation

30
Q

Dynamic bone disease may lead to: (3)

A

Bone pain
Artery calcification
Tumoral calcinosis

31
Q

Calciphylaxis is the ___ of ___ vessels due to a massive ____ classification

A

blockage
Blood vessel
vascular

32
Q

The best treatment for calcium and phosphate metabolism disorders is ____ and includes low ___ diet, monitoring, and ___ binding agents

A

Protentional
phosphate
phosphate

33
Q

In calcium and phosphate metabolism disorders keep PTH between - pg/mL

A

150-300

34
Q

The leading cause for mortality in CKD patients is ___. Most patients do not reach stage __.

A

Cardiovascular

5

35
Q

CKD patients have ___ times more chance to suffer from CV disease

A

10-200

36
Q

The specific risk factors for ischemic vascular disease in CKD patients include: (5)

A
  1. Anemia
  2. Hyperphosphatemia
  3. Hyperparathyroidism
  4. Increased FGF23
  5. OSA (Obstructive sleep apnea)
  6. Systemic inflammation
37
Q

What may be the reason for hypotension in CKD patients?

A

Salt wasting syndrome or decreased LV function

38
Q

What are the common CV disease CKD patients may suffer from? (4)

A

Ischemic vascular disease
CHF
HTN
LVH

39
Q

In CKD + DM or proteinuria> 1 g/24h, what is the recommended BP?

A

130/80

40
Q

Which drugs are recommended for BP treatment in CKD patients? (2)

A

ARBs and ACEi

41
Q

What are the S/E of ARB and ACEi in CKD patients? (2)

A
  1. AKI

2. Hyperkalemia

42
Q

Pericardial disease is a definitive indication for emergency ___

A

dialysis

43
Q

Normocytic normochromic anemia may appear in CKD stage ___, and will always present in stage ___

A

3

4

44
Q

The reason for anemia in CKD patients is: (5)

A
  1. Decreased EPO production
  2. Decreased iron utilization
  3. Hyperparathyroidism
  4. B12/folic acid deficiency
  5. Aluminum toxicity
45
Q

Treat CKD anemia with: (3)

A
  1. EPO
  2. Iron
  3. B12/folic acid
46
Q

CKD patients may encounter abnormal hemostasis, treatment include: (5)

A 
Desmopressin
Cryoprecipitate
Estrogen IV
Blood transfusion
EPO
47
Q

General treatment for hemostasis disorders in CKD patients include:

A

Heparin

48
Q

Why NOAC is not recommended in CKD patients?

A

Renal excretion

49
Q

In which stage of CKD will neuromuscular disorders start?

A

3

50
Q

What is uremic fetor

A

Urine like odor on the breath, from the break down of urea to ammonia in saliva

51
Q

What is the GFR of each stage of CKD?

A
  1. Normal or high >=90
  2. Mildly decreased =60-89
    3a. Mildly to moderately decreased= 45-59
    3b. Moderately to severely decreased
  3. Severely decreased 15-29
  4. Kidney failure <15

Harrison's Principles of Internal Medicine 20 (163 decks)

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