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House Clinical Pathology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Chronic kidney disease (CKD) is defined by the presence of _________ or ———— for ___________, irrespective of the cause.

A

kidney damage or decreased glomerular filtration rate (GFR)

three or more months

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2
Q

Chronic kidney disease (CKD)

This ________ duration distinguishes chronic from acute kidney disease.

A

three-month

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3
Q

Chronic kidney disease (CKD)

For patients being evaluated for elevated _________ or reduced _________, it is important to distinguish those who have relatively stable ______ from those who have ________________, which may be ongoing and reversible.

A

serum creatinine

estimated glomerular filtration rate (eGFR)

CKD

acute or subacute kidney injury

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4
Q

Acute kidney injury (AKI) is defined by a rise in the _________ level that has developed within _____________

A

serum creatinine
hours to days.

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5
Q

Subacute kidney injury (also called _____________) informally refers to any decline in kidney function that evolves over more than ________ but less than _______

A

acute kidney disease

48 hours

three months.

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6
Q

CKD patients may present with symptoms and signs resulting directly from diminished kidney function, such as ________ or _______.

A

edema or hypertension

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7
Q

CKD patients

There may be no clinical symptoms, and kidney disease is often detected in patients when ______________,________________, or ____________ is discovered incidentally.

A

an elevated serum creatinine, reduced estimated glomerular filtration rate (eGFR), or an abnormal urinalysis

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8
Q

IN CKD patients

Radiographic findings (eg, _____ and _____ kidneys [by ultrasound] suggesting chronic damage, multiple bilateral renal ______ with enlarged kidneys suggestive of _____________) may be observed on imaging performed for some other reason.

A

small and echogenic

cysts

polycystic kidney disease

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9
Q

Depending upon the duration and severity of CKD, patients may also present with symptoms and/or signs of prolonged kidney failure which includes ______ and easy _______, anorexia, vomiting, pruritus, and, in very advanced stages, with _________ or _________.

A

weakness

fatigability

encephalopathy or seizures

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10
Q

Azotaemia – Increase in blood concentration of _____________________________

A

nitrogenous waste products of metabolism

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11
Q

Uraemia – build up of _______ in blood in people with __________

A

metabolic toxins

kidney failure

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12
Q

Reduced urine output (ie, oliguria or anuria) is often observed with CKD alone
T/F

Oliguria/Anuria may indicate at least some component of ———————

A

F

Seldom

acute kidney injury (AKI).

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13
Q

Oliguria or anuria may be present among patients with _________________ on ________, such as may be observed in a patient with chronic ________ who develops acute __________.

A

AKI superimposed on CKD

obstruction

urinary retention

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14
Q

Similarly, anuria as a result of severe or prolonged _____, bilateral ___________ or bilateral ________ (eg, due to a ___________) may occur in patients with underlying CKD.

A

shock

urinary tract obstruction

renal arterial occlusion

dissecting aortic aneurysm

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15
Q

The most common laboratory findings in patients with CKD include increased ______________ and ___________.

A

serum creatinine and blood urea nitrogen

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16
Q

Other common laboratory abnormalities that may be part of the clinical picture in CKD include _____, ____phosphatemia, _____kalemia, metabolic ______, ____calcemia, and _______ parathyroid hormone (PTH).

A

anemia

hyper; hyper; acidosis

hypo

elevated

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17
Q

Urine studies in CKD patients may show ________uria (or ____uria) and/or abnormal _____________ on urine microscopy.

A

protein

albumin

red or white blood cells

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18
Q

Risk factors for CKD

Long-standing ______ and _____ commonly lead to CKD.

The ______ of disease and the _____ should be determined in such patients.

A

diabetes and hypertension

duration; degree of control

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19
Q

Risk factors for CKD

Patients should be asked about a history of prior ———— or _________ to determine if it could have contributed to their CKD.

Prior _____, particularly if ______- requiring, may lead to CKD

A

severe or prolonged acute kidney injury (AKI)

AKI; dialysis

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20
Q

Risk factors for CKD

In addition, the presence of diabetic or hypertensive _______ should be ascertained because patients with _______ have a higher likelihood of having CKD from diabetes and/or hypertension

A

retinopathy

retinopathy

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21
Q

Risk factors for CKD

_____ failure, _____ failure, ______ disease, recurrent and complicated urinary tract infections, and reduced kidney ____ (eg, _____,_______) should be elicited due to their associations with CKD.

A

Heart; liver; autoimmune

mass; nephrectomy, renal agenesis

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22
Q

Risk factors for CKD

Inherited disorders, such as ______,______, and ________ kidney diseases, are relatively common causes of CKD.

Thus, it is important to ask specific questions about ______ in family members, including their history of abnormal _______ or abnormal ______

A

cystic, interstitial, and glomerular

kidney disease

kidney imaging

urine studies

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23
Q

Risk factors for CKD

Patients who have a history of ____ and treatment with _______ may develop CKD from the _____ itself or from ______

A

cancer

chemotherapy or radiotherapy

cancer; its treatment.

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24
Q

Risk factors for CKD

• Patients with renal cell carcinoma often require a partial or complete ________, which can lead to CKD from _______.

Also, patients who are treated with chemotherapy may develop CKD as _____________________ of their treatment.

A

nephrectomy

decreased renal mass

an adverse consequence

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25
Q

Risk factors for CKD

Urinary tract obstruction should be suspected among patients who have a history of prior _____ surgery , prior ___________ surgery, a known or suspected _____ or ______ malignancy, _________ disease involving the bladder, gross hematuria, lower abdominal, pelvic, or flank pain, or in men with lower urinary tract symptoms.

A

urological

pelvic or retroperitoneal

abdominal or retroperitoneal

neurologic

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26
Q

Risk factors for CKD

Inquiry about risk factors for ______,_________, or __________ virus infections, such as a history of intravenous drug use or sexually transmitted disease. Patients with risk factors should be tested for the presence of these viruses when the underlying cause of CKD is not clear.

A

human immunodeficiency, hepatitis C, or hepatitis B

27
Q

Risk factors for CKD

Medications should be reviewed, including for potentially ______ medications eg, prolonged use of _____ for _____ conditions, certain Chinese herbs from “_______ clinics,” or ______ combination agents may each cause chronic interstitial injury that leads to CKD.

A

nephrotoxic

lithium; psychiatric

slimming; analgesic

28
Q

Laboratory assessment of CKD

• Basic metabolic panel that includes ________ for calculation of the _______________

• Complete _____ with ______ differential (“CBC with diff”).

A

serum creatinine

estimated glomerular filtration rate (eGFR).

Blood count; white cell

29
Q

Laboratory assessment of CKD

• Urinalysis using ______ strips ( _____ ) and automated urine microscopy. Urine microscopy is especially helpful if there are __________ , cellular or granular ______, or ______ in the urine.

A

reagent test; dipstick

cellular elements

casts; crystals

30
Q

Laboratory assessment of CKD

Quantification of urine protein and albumin by ____ (or “____”) ___________ ratio (_____) and ___________ ratio (______).

A

random; spot

protein-to-creatinine; UPCR

albumin-to-creatinine ; UACR

31
Q

Laboratory assessment of CKD

serum and urine protein electrophoresis with immunofixation and a serum free light chain assay if ____________ is suspected.

A

monoclonal gammopathy

32
Q

Laboratory assessment of CKD

Patients who are at a high risk for renovascular disease should have dedicated _______ to evaluate for ________.

______ of the _________ is often a first step.

A

imaging; renal artery stenosis

Ultrasound

renal arteries

33
Q

_________ is Considered the best overall index of kidney function.

A

eGFR

34
Q

Normal GFR varies according to ____,____,and ______ , and ____ with age.

A

age, sex, and body size

declines

35
Q

The _____ Creatinine Equation (2009) is used to estimate GFR. Other useful calculators related to kidney disease include ______ and ___________

A

CKD-EPI

MDRD and Cockroft Gault.

36
Q

Screening Tools: Urine Albumin Creatinine Ratio

Urinary albumin-to-creatinine ratio (ACR) is calculated by dividing albumin concentration in ______ by creatinine concentration in _____.

A

milligrams

grams

37
Q

Albumin alone gets more accurate results than albumin:creatinine ratio

T/F

A

F

Creatinine assists in adjusting albumin levels for varying urine concentrations, which allows for more accurate results versus albumin alone.

38
Q

_____ urine albumin-to-creatinine ratio is needed for quantification of proteinuria

A

Spot

39
Q

Screening Tools: Urine Albumin Creatinine Ratio

_________ void preferable

A

First morning

40
Q

Screening Tools: Urine Albumin Creatinine Ratio

24hr urine test is often necessary

T/F

A

F

24hr urine test rarely necessary

41
Q

Criteria for CKD

ACR >____ mg/g

______ of kidney damage (one or more*)

GFR <____ mL/min/1.73 m2

A

30

Markers

60

42
Q

Old Classification of CKD
Stage. Description. Severity
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5

A

Kidney damage with normal or increased GFR; GFR ≥ 90

Kidney damage with mild decrease in GFR; GFR of 60-89

Moderate decrease in GFR; GFR of 30-59

Severe decrease in GFR; GFR of 15-29

Kidney failure; GFR < 15

43
Q

GFR – Glomerular filtration rate

This can be approximately derived by measuring urinary excretion of a substance that is __________, ________, _______ and _________

Only ______ has been seen to meet this criteria

A

completely filtered from the blood

not secreted

not reabsorbed

not metabolized by renal parenchyma

Inulin

44
Q

GFR – Glomerular filtration rate

The _______ from which inulin is cleared or completely removed in 1 min is known as the ______

A

volume of blood

inulin clearance

45
Q

GFR – Glomerular filtration rate

The most widely used biochemical clearance test is based on measurements of _______ in plasma and urine. This _____genous substance is derived mainly from the turnover of ______ in _______ and daily production is relatively constant.

A

creatinine

endo

creatine in muscle

46
Q

Inulin clearance is equal to the GFR.

T/F

A

T

47
Q

Creatinine Clearance = ??

A

u x v mL/min
———
p

48
Q

Creatinine Clearance ‘s formular

What is U, V, and P

A

U = urinary creatinine concentration (μmol/L

V = urine flow rate (mL/min or (L/24 h)/1.44)

P = plasma creatinine concentration (μmol/L)

49
Q

24 hour urine collection

Is easy difficult

Is not prone to errors

T/F

A

F

F

difficult and it is prone to errors

50
Q

eGFR

____________________ (MDRD) study. The ‘___________ ’ formula is commonly used

This formula is for _______ : the result should be multiplied by _____ for females and by _____ for African Caribbean people.

A

Modification of Diet in Renal Disease

four- variable

white males

0.742
1.21

51
Q

It is recommended that values of eGFR greater than 60 mL/min should be reported as ‘____ mL/min’ and regarded as normal in the absence of clinical or laboratory evidence of renal disease.

A

> 60

52
Q

Urea is synthesized in the _____, primarily as a by-product of the _______ of _____

A

liver

deamination of amino acids.

53
Q

____________ represents the major route for nitrogen excretion.

A

Elimination of urea in the urine

54
Q

Serum Urea test

Urea is filtered from the blood by the glomeruli but _________ occurs through _________

A

significant tubular reabsorption

passive diffusion.

55
Q

Plasma urea concentration is a (more or less?) reliable indicator of renal glomerular function than creatinine.

A

Less

56
Q

Tubular reabsorption _____eases at low rates of urine flow (e.g. in fluid depletion), and this can cause ____eased plasma urea concentration even when renal function is normal.

A

incr

incr

57
Q

Cystatin C
This low molecular weight peptide (13 kDa) is produced by _____________

A

all nucleated cells

58
Q

Cystatin C

It is influenced by gender or muscle mass

may be increased in malignancy, hyperthyroidism

May be decreased by treatment with corticosteroids.

A

F (not)
T
F(incr)

59
Q

What substance is better for GFR

Creatinine or Cystatin C

A

Cystatin C

60
Q

Cystatin C

Although not widely available in routine laboratories, measurement may have a role in the detection of early renal impairment in patients in whom creatinine is affected by ____________

A

unusual muscle bulk

61
Q

Chronic kidney disease (CKD) is defined by the presence of __________ or ____________ for___________, irrespective of the cause.

A

kidney damage or reduced glomerular filtration rate (GFR)

three or more months

62
Q

Ajie🖤?

A

Never

63
Q

The morphological complication of hypertension on the kidney is _______ appearance

A

Flea bitten

House Clinical Pathology (45 decks)

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