Chronic Kidney Disease

Question 1

Factors that increase for CKD even in individuals with normal GFR

Answer 1

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

Question 2

Peak GFR attained during the 3rd decade

Answer 2

120 ml/min per1.72 m2

Question 3

A well-studied screening marker fo the presence of systemic microvascular disease and endothelial dysfunction

Answer 3

Presence of albuminuria

Question 4

KDIGO classification of CKD based on estimated
glomerular filtration rate
(GFR) and albuminuria

Answer 4

Question 5

Leading categories of etiologies of CKD

Answer 5

Question 6

Pathophysiology of CKD in general

Answer 6

Two broad sets of mechanism:

1. Initiating mechanisms specific to the underlying etiology
2. Hyperfiltration and hypertrophy of the remaining viable nephrons

Question 7

Definition of CKD

Answer 7

encompassesa spectrum of pathophysiologic processes associated with abnormal kidney function and a progressive decline in GFR

Question 8

Pathophysiology of uremic syndrome

Answer 8

Three spheres of dysfunction:

1. Those consequent to the accumulation of toxins that normally undergo renal excretion
2. Those consequent to the loss of other kidney functions, such as fluid and electrolyte homeostasis and hormone regulation
3. Progressive systemic inflammation and its vascular and nutritional consequences

Question 9

Level of serum bicarbonate concentration in CKD which may require alkali supplementation

Answer 9

20-23 mmol/L

Question 10

Classic lesion of secondary hyperparathyroidism

Answer 10

Osteitis fibrosa cystica

Question 11

GFR level in CKD when changes due to secondary hyperparathyroidism start

Answer 11

GFR <60 mL/min

Question 12

Heralded by livedo reticularis and advances to patches of ischemic necrosis, esp on the legs, thighs, abdomen, and breasts

Answer 12

Calciphylaxis

Question 13

An anticoagulant that is considered a risk factor for calciphylaxis

Answer 13

Warfarin

Question 14

Target PTH level in CKD patients based on KDIGO guidelines

Answer 14

150-300 pg/mL

Question 15

Leading cause of morbidity and mortality in patients at every stage of CKD

Answer 15

Cardovascular disease

Question 16

First line of therapy for CKD patients with cardiac abnormality

Answer 16

Salt restriction

Question 17

An absolute indication for the urgent initiation of dialysis or for intensification of the dialysis prescription in those already receiving dialysis

Answer 17

Uremic pericarditis

Question 18

CKD stage when normocytic normochromic anemia begins

Answer 18

CKD stage 3

Question 19

CKD stage when anemia becomes universal

Answer 19

CKD stage 4

Question 20

Target hemoglobin for CKD

Answer 20

100-115 g/L

Question 21

Indications of and monitoring of toxicity of recombinant erythropoietic agents

Answer 21

Increased risk of stroke in those with Type 2 DM, an increase in thromboembolic events, and perhaps a faster progression of renal decline

Question 22

Stage of CKD when the subtle clinical manifestations of uremic neuromuscular disease usually becomes evident

Answer 22

CKD stage 3

Question 23

Stage of CKD when peripheral neuropathy usually becomes clinically evident

Answer 23

CKD stage 4

Question 24

Characterized by ill-defined sensations of sometimes debilitating discomfort in the legs and feet relieved by frequent leg movement

Answer 24

Restless leg syndrome

Question 25

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

Answer 25

Uremic fetor

Question 26

Level of GFR when pregnancy is associated with high rate of spontaneous abortion

Answer 26

GFR <=40 ml/min

Question 27

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

Answer 27

Nephrogenic fibrosing dermopathy

Question 28

Uremic syndrome

Answer 28

loss of appetite, weight loss, nausea, peripheral edema, muscle cramps, pruritus, and restless legs

Question 29

Reasons why renal biopsy is not advised in a patient with bilaterally small kidney

Answer 29

1. Technical difficulty with greater likelihood of bleeding and other adverse consequences
2. There is usually so much scarring that the underlying diseases may not be apparent
3. The window of opportunity to render disease-specific therapy has passed

Question 30

Contraindications to kidney biopsy

Answer 30

Bilaterally small kidneys
Uncontrolled hypertension
Acute UTI
Bleeding diathesis (including ongoing coagulation)
Severe obesity

Question 31

Most important diagnostic step in CKD

Answer 31

Distinguish newly diagnosed CKD from acute or subacute renal failure

Question 32

Target BP in proteinuric CKD patients

Answer 32

130/80 mmHg

Question 33

Clear indications for initiation of renal replacement therapy

Answer 33

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