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Nephrology > 305 CKD > Flashcards

305 CKD Flashcards

1
Q

Leading categories of CKD

A

Diabetic nephropathy
Glomerulonephritis
Hypertension associated CKD
Autosomal dominant Polycystic kidney disease

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2
Q

Where is urinary Potassium mediated

A

Aldosterone dependent secretion in distal nephron

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3
Q

True or false. Hyponatemia is commonly found in CKD

A

False.

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4
Q

When is Hyperkalemia and hyperchloremic metabolic acidosis present

A

CKD stage 1-3
Diabetic nephropathy
Tubulointerstitial disease

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5
Q

Part of the family of phosphatonin that promote renal phosphate secretion

A

FGF-23

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6
Q

Target PTH in CKD

A

150-300 pg/ml

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7
Q

Considered a risk factor for calciphylaxis

A

Warfarin use

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8
Q

Vascular occlusion in association with extensive vascular and soft tissue calcification

A

Calciphylaxis

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9
Q

Non calclun containing polymers

A

Sevelamer

Lanthanum

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10
Q

Primary cause of anemia in CKD

A

Insufficient production of EPO

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11
Q

Target hemoglobin in CKD

A

100-115 g/L

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12
Q

Causes skin discoloration in CKD

A

Deposition of urochromes

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13
Q

Most vexing dermatologic problem of CKD

A

Pruritus

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14
Q

Target FBC and HbA1c of CKD

A

FBS 90-130 mg/dl

HbA1c of less than 7%

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15
Q

Daily protein in CKD not on HD

A

0.6-0.8 g/kg/day with at least 50% high biologic value

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16
Q

Dietary protein in CKD patient on HD

A

0.9 mg/kg/ BW

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17
Q

Top 3 causes of CKD worldwide

A

Diabetes mellitus
Hypertension
Glomerulonephritis

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18
Q

Decline in CrCl in normal people? In diabetes?

A

Age 30, decline of EGFR by 1% per year

Diabetes: 10-12% decline per year

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19
Q

Target HCO3 in CKD

A

HCO3 of 22-26 meq

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20
Q

When AVF creation done? In diabetic? Other cause?

A

Diabetic: EGFR of 25 ml/min

Other causes: EGFR of 15 ml/min

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21
Q

Dietary protein in CKD

A

On ketoanalogue: 0.3 mg/kg/ BW
CKD with symptoms not on HD: 0.6 mg/ Kg/BW
CKD with no symptoms not on HD: 0.8 mg/Kg/BW
CKD on HD: 0.9-1.2 mg/kg/ BW

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22
Q

defined by structural or functional abnormalities of the kidney, with or without decreased GFR

A

Chronic kidney disease

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23
Q

When can label a patient with CKD

A

GFR less than 60 ml/min/1.73m2 for more than 3 months with or without kidney damage

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24
Q

when is the peak GFR

A

third decade of life

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25
Q

what is the annual decline in GFR after the peak

A

1 ml/min/year

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26
Q

True or false. Women have lover GFR than men

A

True.

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27
Q

6 mechanism of renal progression

A
  1. glomerular hypertension and proteinuria 2. proteinuria linked interstitial mononuclear and accumulation 3.cytokine and chemokine bath, 4. mononuclear cell infiltration 5.epithelial mesenchymal transition and 6. fibrosis
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28
Q

True or false. CKD progression is closely linked to both the GFR and the amount of the albuminuria

A

True.

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29
Q

Represents the stage of CKD where the accumulation of toxins, fluids, and electrolytes normally excreted by the kidneys leads to death unless the toxins are removed by renal replacement therapy

A

End stage renal disease

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30
Q

Two broad sets of mechanisms of damage in the pathophysiology of CKD

A

1.initiating mechanism specific to the underlying etiology and 2 hyperfiltration and hypertrophy of the remaining viable nephrons

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31
Q

helpful in monitoring nephron injury and response to therapy

A

measurement of albuminuria

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32
Q

replaced the 24 hour urine collection as measure pointing to glomerular injury

A

urinary albumin creatinine ratio (UACR)

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33
Q

UACR value that serves as marker for early detection of primary kidney disease

A

Above 17 mg in men and above 25 mg in women

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34
Q

True or false. UACR serves not only as maker for early detection of primary kidney disease but for systemic microvascular disease as well

A

True.

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35
Q

GFR categories. G1- G5

A

G1 normal eGFR more than 90 G2 eGFR 60-89 G3a eGFR 45- 59 G3b eGFR 30-44 G4 eGFR 15-29 G5 kidney failure eGFR less than 15

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36
Q

KDIGO persistent albuminuria. A1- A3

A

A1 normal less than 30 mg/d or 3 mg/mmol A2 30-300 mg/dl or 3-30 mg/mmol A3 more than 300 mg/d or 3 mg/mmol

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37
Q

True or false. Stage 1 and 2 CKD are usually asymptomatic and recognition often result from laboratory testing other than suspicion of kidney disease

A

True.

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38
Q

Leading categories of etiologies of CKD

A

diabetic nephropathy, glomerulonephritis, hypertension associated CKD, ADPKD, other cystic and tubulointerstitial nephropathy

39
Q

True or false. When no overt evidence for a primary glomerular or tubulointerstitial disease process is present, CKD is frequently atttributed to hypertension

A

True.

40
Q

three spheres of dysfunction manifested as pathophysiology of uremic syndrome

A

those consequent to the accumulation of toxins that normally undergo renal excretion, 2 those consequent to the loss of other kidney functions, 3. progressive systemic inflammation and its vascular and nutritional consequences

41
Q

True or false. Hyponatremia is not commonly seen in CKD patient.

A

True.

42
Q

How is hyponatremia treated in CKD patient?

A

Water restriction

43
Q

True or false. Diuretic resistance with intractable edema and hypertension in advanced CKD may serve as an indication to initiate dialysis

A

True.

44
Q

True or false. Decline in GFR is not necessarily accompanied by a parallel decline in urinary potassium

A

True.

45
Q

What precipitates hyperkalemia in CKD

A

dietary potassium intake, hemolysis, hemorrhage, transfusion of stored red blooc cells, and metabolic acidosis

46
Q

True or false. Hypokalemia is also not common in CKD patients

A

True.

47
Q

True or false. Metabolic acidosis is a common disturbance in advanced CKD

A

True.

48
Q

When is alkali supplementation recommended

A

sodium bicarbonate levels are below 20-23 mmol/L

49
Q

When does bone manifestation of CKD occur

A

occurs when GFR falls below 60 ml/min

50
Q

Pathophysiology of secondary hyperparathyroidism in CKD

A
  1. declining GFR leads to phosphate retention, 2. retained phosphate stimulate FGF-23 and PTH, 3. FGF-23 leads to decreased ionized calcium, further phosphate retention and low calcitriol
51
Q

part of a family of phosphatonins that promotes renal phosphate excretion

A

FGF-23

52
Q

Devastating condition seen in advanced CKD where there is evidence of vascular occlusion in association with extensive vascular and soft tissue calcification

A

Calciphylaxis

53
Q

Considered a risk factor for calciphylaxis

A

warfarin treatment

54
Q

What is the optimal management of secondary hyperparathyroidism and osteitis fibrosa

A

prevention

55
Q

Calcium based phosphate binders

A

calcium carbonate and calcium acetate

56
Q

Major side effect of calcium based phosphate binders

A

calcium accumulation and hypercalcemia

57
Q

non calcium containing phosphate binders

A

sevelamer and lanthanum

58
Q

what is the target PTH level

A

150- 300 pg/ml

59
Q

Leading cause of morbidity and mortality in patients at every stage of CKD

A

cardiovascular disease

60
Q

True or false. Cardiac troponin levels are frequently elevated in CKD without evidence of acute ischemia

A

True.

61
Q

largest increment in cardiovascular mortality in dialysis patient

A

congestive heart failure and sudden death

62
Q

most common complication of CKD

A

hypertension

63
Q

Strongest risk factor for cardiovascular morbidity and mortality in patients with CKD

A

LVH and dilated cardiomyopathy

64
Q

True or false. In epidemiologic studies, low blood pressure actually carries a worse prognosis than does high blood pressure

A

True.

65
Q

True or false. Exogenous erythropoiesis- stimulating agents can increase blood pressure and the requirement for antihypertensive drugs

A

True.

66
Q

When should blood pressure in CKD be lowered to 130/80 mmHg

A

in CKD patients with diabetes and proteinuria of more than 1 g per 24 hrs

67
Q

Firs line of therapy for hypertension in CKD patients

A

salt restriction

68
Q

Diagnostic of pericarditis

A

chest pain with respiratory accentuation accompanied by friction rub

69
Q

Classic ECG finding of pericarditis

A

PR interval depression and diffuse ST segment elevation

70
Q

True or false. Uremic pericarditis is an absolute indication for urgent initiation of hemodialysis or intensification of dialysis

A

True.

71
Q

Stage anemia is first observed and when does it become universal

A

Anemia is observed as early as stage 3 CKD and universal by stage 4

72
Q

Primary cause of anemia in CKD patients

A

insufficient production of EPO by the diseased kidney

73
Q

Other causes of CKD

A

relative deficiency of EPO, diminished RBC survival, IDA, chronic inflammation, folate and vitamin B12 deficiency, hemoglobinopathy, hyperparathyroidism

74
Q

what is the effect of blood transfusion to CKD patient waiting for renal transplant

A

frequent blood transfusion can lead to development of alloantibodies that can sensitize the patient to donor kidney antigens and make renal transplantation more problematic

75
Q

What can temporarily reverse abnormal bleeding time and coagulopathy in patients with renal failure

A

desmopressin, cryoprecipitate, IV conjugated estrogen, blood transfusion and ESA therapy

76
Q

derives from breakdown of urea to ammonia in saliva and often associated with an unpleasant metallic taste

A

uremic fetor

77
Q

True or false. Because the kidney contributes to insulin removal from the circulation, plasma levels of insulin are slightly to moderately elevated in most uremic patients both in the fasting and postprandial states

A

True.

78
Q

GFR associated with higher rate of spontaneous abortion

A

GFR less than 40 ml/min

79
Q

True or false. Pregnancy may hasten the progression of kidney disease itself.

A

True.

80
Q

Most vexing manifestations of the uremic state

A

Pruritus

81
Q

pigmented metabolites in CKD

A

urochromes

82
Q

Skin condition in CKD consisting of progressive subcutaneous induration in the arms and legs with history of exposure to gadolinium

A

nephrogenic fibrosing dermopathy

83
Q

GFR when CKD patients should minimize exposure to gadolinium

A

GFR 30-59 ml/min

84
Q

GFR when gadolinium should be avoided unless medically necessary

A

CKD stage 4-5 of GFR less than 30 ml/min

85
Q

differential for unexplained CKD in patients aged above 35 with anemia, normal serum calcium

A

multiple myeloma

86
Q

an indication for therapy with ACEI or ARBS

A

24h urine protein excretion more than 300 mg

87
Q

Conditions where kidney size may be normal in the face of CKD

A

diabetic nephropathy, amyloidosis and HIV nephropathy

88
Q

a discrepancy in kidney length suggests either a unilateral development abnormality or renovascular disease with arterial insufficiency

A

discrepancy of more than 1 cm

89
Q

Reasons why kidney biopsy in patients with bilaterally small kidneys are not advised (3)

A
  1. technically difficult, 2. much scarring that underlying disease may not be apparent, 3. window of opportunity to render disease specific therapy has passed
90
Q

Other contraindicati0on to kidney biopsy

A

uncontrolled hypertension, active UTI, bleeding diasthesis, severe obesity

91
Q

important in slowing the progression of CKD

A

control of glomerular hypertension

92
Q

surrogate for improved renal outcome

A

reduction in proteinuria

93
Q

among calcium channel blockers, these agents exhibit superior antiproteinuri and renoprotective effects

A

verapamil and diltiazem

Nephrology (6 decks)

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