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Applied Pathophysiology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Basic functional unit in kidney is “_____”

A

nephron

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2
Q

Each kidney has about ___ ____ nephrons

A

1 million

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3
Q

Plasma fluids & solutes are filtered (except ____ _____)

A

plasma proteins
- if they’re proteins it’s an indication of kidney disease

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4
Q

What are the 2 major kidney functions?

A
  1. Remove WASTE material ingested
    or produced by metabolism
  2. Control VOLUME and ELECTROLYTE composition of body fluids
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5
Q

Normally blood flow to kidneys is about ___ of cardiac output (_____)

A

22%

1100 ml/min

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6
Q

Outline the blood flow to kidneys starting with the renal artery

A

Renal artery enters kidney via hilum, branches to smaller arteries, AFFERENT arterioles, and glomerular capillaries

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7
Q

Outline the blood flow exiting the kidneys starting with the distal end

A

Distal ends of capillaries of glomerulus coalesce to form EFFERENT arterioles, capillary network, and peritubular capillaries that surrounds renal tubules

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8
Q

What are the 6 main parts of a kidney nephron?

A
  1. Bowman’s capsule
  2. Proximal tubule
  3. Loop of Henle
  4. Distal tubule
  5. Connecting tubule
  6. Collecting tubule
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9
Q

What is the Glomerulus?

A

CLUSTER of tiny CAPILLARIES that receives blood from the AFFERENT arteriole
(& is surrounded by Bowman’s capsule)

Blood passes through these capillaries & FILTERED
under PRESSURE into BOWMAN’S capsule

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10
Q

What happens if the Glomerulus is damaged?

A

If DAMAGED, can lead to chronic kidney disease (CKD)

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11
Q

What is the Glomerular Filtration Rate (GFR)?

A

volume of blood filtered by GLOMERULUS/MIN

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12
Q

What is the normal GFR (adult)?

A

100–125 ml/min

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13
Q

What does GFR depend on?

A

depends on AGE and GENDER

(increase GFR in males generally, as age increases level of GFR decreases)

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14
Q

What is estimated GFR & what is it used for?

A
  • ESTIMATED GFR is calculated using equations
  • used for STAGING CKD and drug dosing
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15
Q

What are the major functions of the kidney?

A
  • Excretion of metabolic WASTE products and chemicals
  • Regulation of WATER and ELECTROLYTE balances
  • Regulation of body fluid OSMOLALITY and electrolyte concentrations
  • Regulation of ARTERIAL PRESSURE
  • Regulation of ACID-BASE balance
  • Regulation of ERYTHROCYTE production
  • Secretion, metabolism, and excretion of HORMONES
  • GLUCONEOGENESIS
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16
Q

What does urine formation result from?

A
  • glomerular filtration
  • tubular reabsorption
  • tubular secretion
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17
Q

What is urinary excretion (i.e. what is it calculated by)?

A

Excretion = Filtration - Reabsorption + Secretion

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18
Q

Describe what happens in the Proximal convoluted tubules?

A
  • PLASMA fluid filtered from GLOMERULUS flows into Bowman’s capsule and then PROXIMAL tubule
  • About 80% of the glomerular ultrafiltrate is REABSORBED into blood as it passes through PROXIMAL tubule
    (80% of total - not of just glucose for ex)
  • Nutrients (GLUCOSE, AMINO ACIDS, electrolytes eg Na+, K+, Cl-, HCO3-) are reabsorbed
  • Some molecules are SECRETED into the tubules (eg CREATININE, URIC ACID, some DRUGS
  • from blood –> tubules
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19
Q

What is imp. about creatinine?

A

by-product of metabolism in muscle

is secreted but not reabsorbed in the proximal convoluted tubule –> gives indication of how well the kidneys are working

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20
Q

Proximal tubules have ___ _____ for ___ and _____ reabsorption

A

HIGH CAPACITY

ACTIVE

PASSIVE

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21
Q

In proximal tubule reabsorption disorders (eg Fanconi Syndrome) patients may present:

A
  • bone disease (rickets)
  • metabolic acidosis
  • hypophosphatemia
  • hypokalemia
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22
Q

What is an example of a proximal tubule reabsorption disorder?

A

Fanconi syndrome

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23
Q

The proximal tubules:

A
  • Reabsorb about 65% of the filtered Na+, K+, Cl-, HCO3-
  • Reabsorb ALL filtered GLUCOSE and AMINO ACIDS.
  • secrete ORGANIC ACIDS, BASES, and HYDROGEN ions into tubular lumen
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24
Q

What happens in the Loop of Henle?

A
  • Fluid flows from proximal tubule into loop of Henle
  • Primary role of the loop of Henle is REABSORPTION of
    WATER, Na+ AND Cl-, Mg2+
  • LOOP DIURETICS BLOCK reabsorption of Na+ and WATER in ascending loop of Henle (eg furosemide –> potent diuretic that reduce edema in pathology cases)
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25
Q

What happens in the Distal convoluted tubule?

A
  • Reabsorption of Na+ and WATER
  • Secretion of K+, H+, PO4-
  • THIAZIDE diuretics
    (eg hydrochlorothiazide, chlorthalidone, metolazone)
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26
Q

What happens in the Thin descending loop of Henle?

A
  • HIGHLY permeable to WATER and MODERATELY permeable to most SOLUTES
  • has FEW mitochondria and LITTLE or no active REABSORPTION.
27
Q

What happens in the Thick ascending loop of Henle?

A
  • reabsorbs about 25% of filtered Na+, K+, Cl-
  • reabsorbs LARGE amounts of Ca2+, HCO3-, Mg2+
  • secretes H+ into tubular lumen
28
Q

What happens in the Early distal tubule?

A
  • has MOST characteristics of THICK ascending loop of Henle
  • reabsorbs Na+, Cl-, Ca2+, Mg2+
  • IMPERMEABLE to WATER and UREA
29
Q

What happens in the Late distal tubules and cortical
collecting tubules?

A
  • PRINCIPLE cells REABSORB Na+ from lumen, SECRETE K+ into lumen
  • Type A INTERCALATED cells REABSORB K+, HCO3-, SECRETE H+
  • WATER reabsorption from this tubular segment is controlled by antidiuretic hormone (ADH)
30
Q

What happens in the Collecting duct?

A
  • REABSORB Na+
  • SECRETE K+ (ALDOSTERONE dependent)
  • ALDOSTERONE ANTAGONISTS (eg spironolactone, eplerenone)
  • Antidiuretic hormone (ADH; vasopressin): controls H2O
    permeability in collecting duct
  • ADH DEFICIENCY causes DIABETES INSIPIDUS
  • ACID-BASE balance: EXCRETION of ACIDS
31
Q

ADH deficiency causes…

A

diabetes insipidus
- b/c body tries to get rid of glucose so urinates a lot

32
Q

What happens in the Medullary collecting ducts?

A
  • ACTIVELY reabsorb Na+ and secrete H+
  • PERMEABLE to UREA (urea reabsorbed in these tubular segments)
  • reabsorption of WATER in medullary collecting
    ducts is controlled by ADH
33
Q

ADH plays an imp. role in…

A

reabsorption of water

34
Q

Describe the control of acid base balance by kidneys

A

Kidney regulates acid base balance and maintain blood pH within the normal range (7.35–7.45)

35
Q

pH<7.35 =

A

Acidosis

Renal correction of acidosis:
↑ excretion of H+
↑ reabsorption of HCO3 −

36
Q

pH>7.45 =

A

Alkalosis

Renal correction of alkalosis:
↓ secretion of H+
↑ excretion of HCO3 −

37
Q

What controls BP by kidneys?

A

Renin-Angiotensin System (RAS)

38
Q

Describe hormone production by kidneys

A

Kidney produces ERYTHROPOIETIN, the hormone that stimulates production of red blood cells (RBC) in the BONE MARROW.

39
Q

During _____, production and release of erythropoietin from the kidneys are INCREASED.

A

anemia
- tries to produce/release more RBCs

When OXYGEN level in BLOOD FALLS below normal, kidneys respond by SECRETING erythropoietin.

40
Q

When OXYGEN level in BLOOD FALLS below normal, kidneys respond by…

A

secreting erythropoietin.

41
Q

In CHRONIC KIDNEY DISEASE, erythropoietin level is _____ contributing to _____ in those patients.

A

REDUCED

ANEMIA

42
Q

What is the definition of Chronic Kidney Disease (CKD)?

A

Chronic Kidney Disease (CKD) is a term used to describe conditions that DAMAGE kidneys or cause REDUCED kidney function over months or years (>3 MONTHS).

43
Q

What are the causes of Chronic Kidney Disease (CKD)?

A
  • DIABETES
  • HIGH BLOOD PRESSURE
  • glomerulonephritis (INFLAMMATION of glomeruli)
  • interstitial nephritis (inflammation of tubules and
    surrounding structures
  • PROLONGED urinary tract OBSTRUCTION (eg enlarged prostate, kidney stones, cancers)
  • RECURRENT kidney INFECTION (pyelonephritis)
  • Inherited kidney disease (polycystic kidney disease)
  • vesicoureteral reflux (urine back up into kidneys)
44
Q

What are the 3 MAIN causes of Chronic Kidney Disease (CKD)?

A
  1. Diabetic kidney disease
  2. Hypertensive nephrosclerosis
  3. Glomerulonephritis
45
Q

Describe how Diabetic kidney disease relates to Chronic Kidney Disease (CKD)

A
  • Patients with DIABETES (both types) are at RISK of chronic kidney disease
  • Characterized by GLOMERULOSCLEROSIS & TUBULOINTERSTITIAL FIBROSIS
  • function of tissues in kidney damage over time & therefore will have some parts being non-functional
  • Patients with diabetes should be screened YEARLY for CKD
46
Q

Describe how Hypertensive nephrosclerosis relates to Chronic Kidney Disease (CKD)

A
  • LONG term hypertension (>10 years)
  • POORLY controlled hypertension
  • Characterized by GLOMERULOSCLEROSIS and REDUCED glomerular blood flow
  • Unlike diabetic CKD, it is associated with LOWER levels of PROTEINURIA (<0.5 g/d)

(may not be diagnosed b/c may not have symptoms)

47
Q

Describe how Glomerulonephritis relates to Chronic Kidney Disease (CKD)

A
  • Caused by ACTIVATION of IMMUNE system leading to INFLAMMATION of glomerulus
  • VIRUSES, BACTERIA, PROTEINS, etc. can promote activation of immune system (eg POST-STREPTOCOCCAL glomerulonephritis)
  • May cause SEVERE proteinuria (>2 g/day)
  • Treatment by IMMUNOSUPPRESSANT drugs (only if REALLY needed - inf. should be eliminated before using those drugs)
48
Q

Factors that can increase risk of chronic kidney disease:

A
  • DIABETES
  • HIGH BLOOD PRESSURE
  • heart (cardiovascular) disease
  • SMOKING
  • OBESITY
  • race (↑Black, native American or Asian American)
  • family history of kidney disease
  • abnormal kidney structure
  • older age

** frequent use of drugs that can damage kidneys (only given when needed, current dose & used when needed)

49
Q

What are signs & symptoms of CKD?

A
  • fatigue, weakness, loss of appetite
  • mental confusion
  • nausea, vomiting (b/c of imbalance in electrolytes for ex)
  • peripheral neuropathies
  • bleeding, ANEMIA (b/c less RBC prod.)
  • EDEMA (puffy ears, legs & ankles)
  • WEIGHT GAIN due to accumulation of FLUID)
  • not real weight gain
  • hypertension
  • METABOLIC ACIDOSIS
  • changes in urine output (volume, consistency)
  • foaming urine (indicates albuminurea)
50
Q

What are the blood test in CKD?

A
  • serum creatinine (↑)
  • estimated glomerular filtration rate (eGFR) (↓)
  • blood urea nitrogen (BUN) (↑)
  • potassium (↑)
  • phosphorus (↑)
  • glucose (to check diabetes)
  • triglycerides and LPL
  • CBC (hemoglobin (↓), RBC (↓) (help test anemia)
  • albumin (↓) (losing albumin daily)
  • bicarbonate (↓); metabolic acidosis
51
Q

What is the Creatinine blood test?

A
  • Creatinine is a byproduct of MUSCLE METABOLISM that is filtered at glomerulus and is NOT reabsorbed.
  • Creatinine is used as a MARKER of glomerular filtration rate (GFR).
  • Serum creatinine levels remain within normal range in healthy individuals.
  • In chronic kidney disease, IMPAIRED renal FILTRATION leads to elevated serum creatinine levels.

** MUSCLE loss during chronic diseases can lead to ELEVATED creatinine level.

52
Q

_____ loss during chronic diseases can lead to ELEVATED creatinine level.

A

MUSCLE
- b/c muscle mass is reduced, the creatinine is down (b/c linked to muscle mass)

53
Q

What is the Urine test for CKD?

A

** protein (albumin ↑)

** blood (↑ RBC in urine)

** RBC and WBC casts

  • renal tubular epithelial cells/cylinders are indication of urine problem in kidneys
  • albumin/creatinine ratio (ACR)
54
Q

What are other diagnostic tests for CKD?

A
  • biopsy (needle) and histopathology assessment (tissue sections)
  • imaging (ultrasound, CT scan, MRI)
55
Q

What is Stage 1 eGFR result & what does it mean for CKD?

A

90 or higher

  • mild kidney damage
  • kidneys work as well as normal
56
Q

What is Stage 2 eGFR result & what does it mean for CKD?

A

60-89

  • mild kidney damage
  • kidneys still work well
57
Q

What is Stage 3a eGFR result & what does it mean for CKD?

A

45-59

  • mild to moderate kidney damage
  • kidneys don’t work as well as they should
58
Q

What is Stage 3b eGFR result & what does it mean for CKD?

A

30-44

  • moderate to severe damage
  • kidneys don’t work as well as they should
59
Q

What is Stage 4 eGFR result & what does it mean for CKD?

A

15-29

  • severe kidney damage
  • kidneys are close to not working at all
60
Q

What is Stage 5 eGFR result & what does it mean for CKD?

A

less than 15

  • most severe kidney damage
  • kidneys are very close to not working or have stopped working (failed)
61
Q

What are the treatment of symptoms for CKD?

A
  • EDEMA/SWELLING: low sodium diet; diuretics
  • HYPERKALEMIA (↑blood K+): low potassium diet, drugs
  • HYPERPHOSPHATEMIA (↑blood phosphorus):
    low phosphorus diet, phosphate binding drugs
  • HYPERMAGNESEMIA (↑blood magnesium)
  • avoid medications that contain magnesium (e.g. certain antacids, Mg supplements, multi-vitamins)
  • METABOLIC ACIDOSIS: sodium bicarbonate tablets
  • ANEMIA: injectable erythropoietin
  • HYPERTENSION: low Na+ diet, anti-hypertensive drugs
  • BLOOD GLUCOSE (if diabetic): diet, hypoglycemic drugs
  • UREMIC PRURITUS:
  • keep skin moisturized - steroid creams
  • medications
  • UVB phototherapy
  • GOUT (due to impaired uric acid secretion): uric acid lowering drugs (eg allopurinol)
  • CONTROL RISK FACTORS (smoking, obesity)
62
Q

What are the end-stage renal disease treatment strategies for CKD?

A
  • dialysis
  • kidney transplant
  • supportive care

(irreversible)

63
Q

What are important pharmacologic concentrations?

A
  • ADJUST drug DOSES for kidney function (based on GFR)
  • Avoid NEPHROTOXIC drugs (eg anti-inflammatory (NSAIDS) such as ibuprofen, naproxen, high doses ASA)
  • Try to avoid drugs that are ELIMINATED by KIDNEY
  • Over the counter drugs: pharmacist/physician ADVICE
  • HERBAL drugs are NOT recommended

Applied Pathophysiology (34 decks)

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