7.1 CKD Flashcards
3 contributions to glomerular filtration barrier
- endothelial cells
- negative charged basement membrane
- podocyte foot processes
how is albumin able to be excreted in urine?
abnormal, must have damage to glomerular filtration barrier
how to treat albuminuria
ARB/ACEi
-reduces GFR
-reduce glomerular pressure from capillaries
=reduce protein in blood
explain how T2DM poorly controlled can lead to CKD
damage to blood vessels, efferent arteriole can’t constrict or dilate appropriately so can cause diabetic nephropathy
explain how HTN can lead to CKD
higher pressure on glomerulus which overrides its regulatory mechanisms = scarring/damage to capillaries
explain how renovascular disease can lead to CKD
narrowed arteries supplying 1/both kidneys
explain how hyperfiltration can occur in some people with poorly controlled DM
high glucose + Na+ reabsorption in kidneys
less Na+ at end of DCT
detected by macula dense, thinks BP drop
activates RAAS, renin released, aldosterone released
so BP increase
higher glomerular pressure increases GFR and so filtration
1st sign of hyper filtration
microalbuminuria
primary causes of CKD
-polycystic kidney diseease
-ATN
-glomerulonephritis
-recurrent pyelonephritis
secondary causes of CKD
-DM
-HTN
-autoimmune
-renovascular disease
most common cause of CKD
DM
macroscopic appearance of CKD
atrophy of cortex
best test to monitor diabetes in CKD? why not HbA1c?
fasting plasma glucose
kidney failing so EPO low so could be anaemic, so RBCs won’t be surviving normal amount of time
best diuretic in CKD-4 with fluid overload
loop diuretic
why is metabolic acidosis common in CKD?
unable to produce/reabsorb HCO3-
