Chronic Kidney Disease Flashcards
Factors that increase for CKD even in individuals with normal GFR
Small for gestation birth weight,
Childhood obesity,
Hypertension,
Diabetes Mellitus,
Autoimmune disease,
Advanced age,
African ancestry,
A family history of kidney disease,
A previous episode of acute kidney injury,
Presence of proteinuria, abnormal urinary sediment or structureal abdonormalities of the urinary tract
Peak GFR attained during the 3rd decade
120 ml/min per1.72 m2
A well-studied screening marker fo the presence of systemic microvascular disease and endothelial dysfunction
Presence of albuminuria
KDIGO classification of CKD based on estimated
glomerular filtration rate
(GFR) and albuminuria
Leading categories of etiologies of CKD
Pathophysiology of CKD in general
Two broad sets of mechanism:
- Initiating mechanisms specific to the underlying etiology
- Hyperfiltration and hypertrophy of the remaining viable nephrons
Definition of CKD
encompassesa spectrum of pathophysiologic processes associated with abnormal kidney function and a progressive decline in GFR
Pathophysiology of uremic syndrome
Three spheres of dysfunction:
- Those consequent to the accumulation of toxins that normally undergo renal excretion
- Those consequent to the loss of other kidney functions, such as fluid and electrolyte homeostasis and hormone regulation
- Progressive systemic inflammation and its vascular and nutritional consequences
Level of serum bicarbonate concentration in CKD which may require alkali supplementation
20-23 mmol/L
Classic lesion of secondary hyperparathyroidism
Osteitis fibrosa cystica
GFR level in CKD when changes due to secondary hyperparathyroidism start
GFR <60 mL/min
Heralded by livedo reticularis and advances to patches of ischemic necrosis, esp on the legs, thighs, abdomen, and breasts
Calciphylaxis
An anticoagulant that is considered a risk factor for calciphylaxis
Warfarin
Target PTH level in CKD patients based on KDIGO guidelines
150-300 pg/mL
Leading cause of morbidity and mortality in patients at every stage of CKD
Cardovascular disease
First line of therapy for CKD patients with cardiac abnormality
Salt restriction
An absolute indication for the urgent initiation of dialysis or for intensification of the dialysis prescription in those already receiving dialysis
Uremic pericarditis
CKD stage when normocytic normochromic anemia begins
CKD stage 3
CKD stage when anemia becomes universal
CKD stage 4
Target hemoglobin for CKD
100-115 g/L
Indications of and monitoring of toxicity of recombinant erythropoietic agents
Increased risk of stroke in those with Type 2 DM, an increase in thromboembolic events, and perhaps a faster progression of renal decline
Stage of CKD when the subtle clinical manifestations of uremic neuromuscular disease usually becomes evident
CKD stage 3
Stage of CKD when peripheral neuropathy usually becomes clinically evident
CKD stage 4
Characterized by ill-defined sensations of sometimes debilitating discomfort in the legs and feet relieved by frequent leg movement
Restless leg syndrome
a urine-like odor on the breath, derives from the breakdown of urea to ammonia in saliva and is often associated with an unpleasant metallic taste
Uremic fetor
Level of GFR when pregnancy is associated with high rate of spontaneous abortion
GFR <=40 ml/min
Progressive subcutaneous induration of the skin, unique to CKD patients, condition is seen very rarely in patients with CKD who have been exposed to magnetic resonance contrast agent gadolinium
Nephrogenic fibrosing dermopathy
Uremic syndrome
loss of appetite, weight loss, nausea, peripheral edema, muscle cramps, pruritus, and restless legs
Reasons why renal biopsy is not advised in a patient with bilaterally small kidney
- Technical difficulty with greater likelihood of bleeding and other adverse consequences
- There is usually so much scarring that the underlying diseases may not be apparent
- The window of opportunity to render disease-specific therapy has passed
Contraindications to kidney biopsy
Bilaterally small kidneys
Uncontrolled hypertension
Acute UTI
Bleeding diathesis (including ongoing coagulation)
Severe obesity
Most important diagnostic step in CKD
Distinguish newly diagnosed CKD from acute or subacute renal failure
Target BP in proteinuric CKD patients
130/80 mmHg
Clear indications for initiation of renal replacement therapy
Uremic pericarditis
Encephalopathy
Intractable muscle cramping
Anorexia
Nausea not attributable to reversible causes such as peptic ulcer disease,
Evidence of malnutrition,
Fluid and electrolyte abnormalities (hyperkalemia or ECFV overload) that are refractory to other measures
