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nephrology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

what is chronic kidney disease?

A

gradual, irreversible decline in kidney function

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2
Q

what is the criteria for chronic kidney disease?

A

decreased eGFR (<60 ml/min/1.83m2) or markers of kidney damage (albuminuria, electrolyte abnormalities, structural or histological renal abnormalities) present for >3 months

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3
Q

what is stage 1 CKD?

A

eGFR >90 with demonstrable kidney damage (e.g. haematuria or proteinuria)

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4
Q

what is stage 2 CKD?

A

eGFR 60-89 with demonstrable kidney damage (e.g. haematuria, proteinuria, or raised albumin/creatinine ratio)

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5
Q

what is stage 3a CKD?

A

eGFR 45-59

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6
Q

what is stage 3b CKD?

A

eGFR 30-44

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7
Q

what is stage 4 CKD?

A

eGFR 15-30

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8
Q

what is stage 5 CKD?

A

eGFR <15

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9
Q

at what stage do patients typically start displaying symptoms?

A

stage 4 or stage 5 CKD

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10
Q

what are the most common causes of CKD?

A
  • diabetic nephropathy
  • hypertension
  • chronic glomerulonephritis
  • chronic pyelonephritis
  • polycystic kidney disease
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11
Q

what is a high urea indicative of?

A

‘protein meal’
urea is a majory nitrogenous waste product of protein metabolism within the liver

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12
Q

what is the diagnostic test for CKD?

A

renal biopsy

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13
Q

what are the glomerular causes of CKD?

A
  • primary (e.g. IgA nephropathy)
  • secondary (e.g. SLE)
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14
Q

what are the vascular causes of CKD?

A
  • vasculitis
  • renal artery stenosis
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15
Q

what are the tubulointerstitial causes of CKD?

A
  • amyloidosis
  • myeloma
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16
Q

what are the congential causes of CKD?

A
  • polycystic kidney disease
  • alport syndrome
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17
Q

what are the systemic causes of CKD?

A
  • diabetes
  • hypertension
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18
Q

what are the developmental causes of CKD?

A
  • vesico-urteric reflux causing chronic pyelonephritis
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19
Q

what are the functions of the kidneys?

A
  • waste excretion
  • regulation of fluid balance
  • acid-base balance
  • erythropoietin production
  • activation of vitamin D
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20
Q

what are the complications of CKD?

A

CRF HEALS
Cardiovascular disease
Renal osteodystrophy
Fluid (oedema)
Hypertension
Electrolyte disturbance - hyperkalaemia, metabolic acidosis
Anaemia
Leg restlessness
Sensory neuropathy

21
Q

what is the most common cause of death in CKD?

A

cardiovascular disease

22
Q

what is renal osteodystrophy?

A

complication of chronic kidney disease that weakens your bones

23
Q

what are the features of renal osteodystrophy?

A
  • reduced bone density (osteoporosis)
  • reduced bone mineralisation (osteomalacia)
  • secondary/tertiary hyperparathyroidism
  • may get spinal osteosclerosis = rugger jersy spine
24
Q

what type of anaemia is seen in CKD?

A

normocytic, normochromic anaemia

25
Q

what is the first-line management of anaemia in CKD?

A

erythropoietin injection

26
Q

what does renal ultrasound show in end-stage renal disease?

A

bilateral shrunken kidneys

27
Q

how does CKD present?

A
  • progressive onset
  • polyuria
  • lethargy
  • pruritus (secondary to uraemia)
  • anorexia
  • insomnia
  • nausea and vomiting
  • hypertension
28
Q

what drugs are contraindicated in CKD?

A
  • NSAIDs
29
Q

what is microalbuminuria?

A

raised levels of albumin in urine

30
Q

what causes microalbuminuria in CKD?

A

diabetic nephropathy

31
Q

how is microalbuminuria screened for?

A

all patients with diabetes >12 years old should undergo regular urinary albumin:creatinine ratio to screen for microalbuminuria

32
Q

what is the diagnostic criteria for microalbuminuria?

A
  • > 2.5 in men
  • > 3.5 in women
33
Q

how do you slow the progression of microalbuminuria?

A

ACEi (e.g. ramipril)

34
Q

how does CKD disease impact bones?

A
  • low vitamin D (1-alpha hydroxylation normally occurs in the kidneys)
  • high phosphate
  • low calcium - due to lack of vitamin D and high phosphate
  • secondary hyperparathyroidism - due to low calcium, high phosphate and low vitamin D
35
Q

what effect does low calcium and raised phosphate have on the thyroid?

A

stimulates parathyroid hyperplasia to produce more parathyroid hormone (PTH) to raise calcium levels

secondary hyperparathyroidism

36
Q

what can sustained parathyroid stimulation lead to?

A

autonomous parathyroid nodule

tertiary hyperparathyroidism

36
Q

what electrolyte disturbances are seen in autonomous parathyroid nodule?

A
  • high PTH
  • hypercalaemia
37
Q

what is alport’s syndrome?

A

due to a defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM)

38
Q

how is alport’s syndrome inherited?

A
  • x-linked dominant pattern
  • more severe in males
39
Q

what are the features of alport’s syndrome?

A
  • normally presents in childhood
  • microscopic haematuria
  • progressive renal failure
  • bilateral sensorineural deafness
  • lenticonus - protrusion of the lens surface into the anterior chamber
  • rentinitis pigmentosa
  • renal biopsy = splitting of lamina densa seen on electron microscopy
40
Q

what is a complications of alport’s syndrome?

A

renal failure in men around 30-40

41
Q

how is alport’s syndrome managed?

A

renal transplant

42
Q

why may a renal transplant fail in alport’s syndrome?

A

failure may be caused by the presence of anti-GBM antibodies leading to a goodpasture’s syndrome like picture

43
Q

how is creatinine clearance calculated?

A

cockcroft-gault formula
* age
* gender
* creatinine
* weight

44
Q

what is the morphology of the kidneys in diabetic nephropathy?

A
  • bilateral renal enlargement - due to osmotic diuresis
  • increased renal blood flow
45
Q

how is hypocalaemia and hyperphosphataemia managed?

A
  • restrict dietary potassium (e.g. dairy products and eggs)
  • sevelamer
  • alfacalcidol
46
Q

what is sevelamer?

A

phosphate binder

47
Q

what is alfacalcidol?

A

a 1-hydroxylated vitamin D analogue

nephrology (5 decks)

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