Adaptations to reductions in kidney function

Question 1

why could the kidneys fail to adapt?

Answer 1

too few nephrons

Question 2

maladaptive adaptations can result in

Answer 2

1. progression of kidney disease

2. complications of CKD in other organs

Question 3

mechanisms of adaptation in glomerular and tubular

Answer 3

1. glomerular : hypertrophy and increased kidney blood flow

2. tubular: alt. in reabsorption and/or secretion of solute

Question 4

true or false in CKD total body sodium remains near normal until late stages

Answer 4

yep

Question 5

what occurs in pt. even when sodium excretion per neprhon rises and DT sodium reabsorption is suppressed

Answer 5

HTN

Question 6

potassium adaptation

Answer 6

increased excretion matched by the increase in potassium secretion

Question 7

failure of adapatation for potassium in CKD

Answer 7

aldosterone deficiency such as during hyporenine (hypoaldosteronism states)

Question 8

treatment for hyperkalemia in CKD

Answer 8

1. low potassium diet

2. resins

Question 9

in early stages of CKD we see the the balance between H+ and HC)3 is normal due to increased in

Answer 9

1. NH3 generations

2. H+ secretion due to an increase in Na/H+ aantiporter and basolateral Na/HCO3 and change from type A to type B

Question 10

in late stages of CKD metabolic acidosis develops due to decreased

Answer 10

1. NH3 generation
2. H+ secretion
3. HC)3 reabsorption

Question 11

tradeoffs to adaptation in the kidney

Answer 11

1. increase NH3 lead to inflammation

2. increase risk of kisney stone

Question 12

tradeoffs to adaptation in the Bone

Answer 12

1.loss of bone calcium due to the mobilization during acidosis leading to osteopenia

Question 13

tradeoffs to adaptation in the muscle

Answer 13

1. increased NH3 requires glutamine which is acquired through the breakdown of muscle “wasting”

Question 14

CKD-MBD

Answer 14

systemic disorder of mineral and bone metabolism due to CKD

Question 15

CKD MBD

1. laboratory
2. Bone
3. Vasculature

Answer 15

1. laboratory: abn. of Ca and Phosphorous, TH or vit. D metabolism
2. Bone: abn. in bone turnover, mineralization, volume and linear growth or strength
3. Vasculature: vascular or other soft tissue calcification

Question 16

abn of mineral metabolism

Answer 16

1. decrease in phosphate excretion
2. decrease in free ionized calcium concentration
3. decrease in alpha-hydroxylation of Vit. D
4. increase in PTH
5. increase in fibroblast growht factor

Question 17

FGF-23 is released from

Answer 17

osteoclasts and osteoblasts in response to hyperphophatemia

Question 18

FGF-23 reduces expression of ________ transporters in the PCT leading to a decreased in reabsorption

Answer 18

phosphate

Question 19

FGF- 23 decreases 1-25 hydroxy vit. D synthesis by inhibiting ______ in tubular cells

Answer 19

1-alpha-hydroxylase activity

Question 20

The ___________ represents the protean manifestations of waste retention

Answer 20

uremic syndrome

Question 21

why do we see anmeia in CKD?

Answer 21

1. iron deficiency
2. reduction in red cell survival
3. EPO resistance due to uremic toxins

Question 22

adaptation to anemia might lead to

Answer 22

1. increased C.O
2. left ventricular hypertrophy and cardiac symptoms
3. decrease in vascular resistance