5.3 and 5.4 Chronic Renal Failure

Question 1

Staging of CKD

Answer 1

1 GFR>90
2 60-98
3 59-30
4 15-29
5<15

Question 2

Increase risk of CKD

Answer 2

HTN

DM

Question 3

CKD define.

Answer 3

> 3 mo of GFR 3 mo abnormal structure or function of kidney

Question 4

UA

Cr

Answer 4

UA: WBC, Waxy casts, proteinuria

cr elevated

Question 5

Imaging

Answer 5

US

Question 6

Sympathetic innervation

Answer 6

T10-L1

Question 7

Ex. Pre-renal

Answer 7

Vasc diseases: Ischemic nephropathy, cholesterol/clot emboli
Nephrosclerosis
Renal artery stenosis

Question 8

Renal causes

Answer 8

Nephrotic, nephritic, cystic disease (ADPKD); Chronic interstitial nephritis

Question 9

In DMI with CKD, How what is happening with hyperfiltration?

Answer 9

Afferent arteriolar vasodilation and/or efferect arteriolar vasoconstriction–>Increase GFR

Glomerular hypertrophy and increase glomerular pressure can cause renal injury

Increase Pgc–>Increase GFR–>Glomerular dmage—>increase permeability of glomerular cap–>Increase urinary protein excretion–>Decrease GFR

This leads to proteinuria and hyperfiltration

Question 10

ACEI in DMI, CKD

Answer 10

ACEI–>Dilate efferent arterioles–>Decrease in Pgc–>Decrease GFR,

Question 11

How can RF cause edema

Answer 11

Total Na+ content increases in RF–>Increase ECF–>Increase Filtration of capillaries into interstitial fluid and edema

Question 12

Use of phosphate binders in CKD

Answer 12

Loss of nephrons–>Increase phosphate concentration–>Decrease Ca2+–>Hyperparathyroidism–>Increase bone reabsorption–>Osteitis fibrosis cystica–>Brown tumor

Phosphate binder hides high phosphate, and absorbs in small intestine