Chronic Kidney Disease Flashcards
Chronic kidney disease (CKD) is defined by the presence of _________ or ———— for ___________, irrespective of the cause.
kidney damage or decreased glomerular filtration rate (GFR)
three or more months
Chronic kidney disease (CKD)
This ________ duration distinguishes chronic from acute kidney disease.
three-month
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.
serum creatinine
estimated glomerular filtration rate (eGFR)
CKD
acute or subacute kidney injury
Acute kidney injury (AKI) is defined by a rise in the _________ level that has developed within _____________
serum creatinine
hours to days.
Subacute kidney injury (also called _____________) informally refers to any decline in kidney function that evolves over more than ________ but less than _______
acute kidney disease
48 hours
three months.
CKD patients may present with symptoms and signs resulting directly from diminished kidney function, such as ________ or _______.
edema or hypertension
CKD patients
There may be no clinical symptoms, and kidney disease is often detected in patients when ______________,________________, or ____________ is discovered incidentally.
an elevated serum creatinine, reduced estimated glomerular filtration rate (eGFR), or an abnormal urinalysis
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.
small and echogenic
cysts
polycystic kidney disease
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 _________.
weakness
fatigability
encephalopathy or seizures
Azotaemia – Increase in blood concentration of _____________________________
nitrogenous waste products of metabolism
Uraemia – build up of _______ in blood in people with __________
metabolic toxins
kidney failure
Reduced urine output (ie, oliguria or anuria) is often observed with CKD alone
T/F
Oliguria/Anuria may indicate at least some component of ———————
F
Seldom
acute kidney injury (AKI).
Oliguria or anuria may be present among patients with _________________ on ________, such as may be observed in a patient with chronic ________ who develops acute __________.
AKI superimposed on CKD
obstruction
urinary retention
Similarly, anuria as a result of severe or prolonged _____, bilateral ___________ or bilateral ________ (eg, due to a ___________) may occur in patients with underlying CKD.
shock
urinary tract obstruction
renal arterial occlusion
dissecting aortic aneurysm
The most common laboratory findings in patients with CKD include increased ______________ and ___________.
serum creatinine and blood urea nitrogen
Other common laboratory abnormalities that may be part of the clinical picture in CKD include _____, ____phosphatemia, _____kalemia, metabolic ______, ____calcemia, and _______ parathyroid hormone (PTH).
anemia
hyper; hyper; acidosis
hypo
elevated
Urine studies in CKD patients may show ________uria (or ____uria) and/or abnormal _____________ on urine microscopy.
protein
albumin
red or white blood cells
Risk factors for CKD
Long-standing ______ and _____ commonly lead to CKD.
The ______ of disease and the _____ should be determined in such patients.
diabetes and hypertension
duration; degree of control
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
severe or prolonged acute kidney injury (AKI)
AKI; dialysis
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
retinopathy
retinopathy
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.
Heart; liver; autoimmune
mass; nephrectomy, renal agenesis
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 ______
cystic, interstitial, and glomerular
kidney disease
kidney imaging
urine studies
Risk factors for CKD
Patients who have a history of ____ and treatment with _______ may develop CKD from the _____ itself or from ______
cancer
chemotherapy or radiotherapy
cancer; its treatment.
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.
nephrectomy
decreased renal mass
an adverse consequence
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.
urological
pelvic or retroperitoneal
abdominal or retroperitoneal
neurologic
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.
human immunodeficiency, hepatitis C, or hepatitis B
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.
nephrotoxic
lithium; psychiatric
slimming; analgesic
Laboratory assessment of CKD
• Basic metabolic panel that includes ________ for calculation of the _______________
• Complete _____ with ______ differential (“CBC with diff”).
serum creatinine
estimated glomerular filtration rate (eGFR).
Blood count; white cell
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.
reagent test; dipstick
cellular elements
casts; crystals
Laboratory assessment of CKD
Quantification of urine protein and albumin by ____ (or “____”) ___________ ratio (_____) and ___________ ratio (______).
random; spot
protein-to-creatinine; UPCR
albumin-to-creatinine ; UACR
Laboratory assessment of CKD
serum and urine protein electrophoresis with immunofixation and a serum free light chain assay if ____________ is suspected.
monoclonal gammopathy
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.
imaging; renal artery stenosis
Ultrasound
renal arteries
_________ is Considered the best overall index of kidney function.
eGFR
Normal GFR varies according to ____,____,and ______ , and ____ with age.
age, sex, and body size
declines
The _____ Creatinine Equation (2009) is used to estimate GFR. Other useful calculators related to kidney disease include ______ and ___________
CKD-EPI
MDRD and Cockroft Gault.
Screening Tools: Urine Albumin Creatinine Ratio
Urinary albumin-to-creatinine ratio (ACR) is calculated by dividing albumin concentration in ______ by creatinine concentration in _____.
milligrams
grams
Albumin alone gets more accurate results than albumin:creatinine ratio
T/F
F
Creatinine assists in adjusting albumin levels for varying urine concentrations, which allows for more accurate results versus albumin alone.
_____ urine albumin-to-creatinine ratio is needed for quantification of proteinuria
Spot
Screening Tools: Urine Albumin Creatinine Ratio
_________ void preferable
First morning
Screening Tools: Urine Albumin Creatinine Ratio
24hr urine test is often necessary
T/F
F
24hr urine test rarely necessary
Criteria for CKD
ACR >____ mg/g
______ of kidney damage (one or more*)
GFR <____ mL/min/1.73 m2
30
Markers
60
Old Classification of CKD
Stage. Description. Severity
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
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
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
completely filtered from the blood
not secreted
not reabsorbed
not metabolized by renal parenchyma
Inulin
GFR – Glomerular filtration rate
The _______ from which inulin is cleared or completely removed in 1 min is known as the ______
volume of blood
inulin clearance
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.
creatinine
endo
creatine in muscle
Inulin clearance is equal to the GFR.
T/F
T
Creatinine Clearance = ??
u x v mL/min
———
p
Creatinine Clearance ‘s formular
What is U, V, and P
U = urinary creatinine concentration (μmol/L
V = urine flow rate (mL/min or (L/24 h)/1.44)
P = plasma creatinine concentration (μmol/L)
24 hour urine collection
Is easy difficult
Is not prone to errors
T/F
F
F
difficult and it is prone to errors
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.
Modification of Diet in Renal Disease
four- variable
white males
0.742
1.21
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.
> 60
Urea is synthesized in the _____, primarily as a by-product of the _______ of _____
liver
deamination of amino acids.
____________ represents the major route for nitrogen excretion.
Elimination of urea in the urine
Serum Urea test
Urea is filtered from the blood by the glomeruli but _________ occurs through _________
significant tubular reabsorption
passive diffusion.
Plasma urea concentration is a (more or less?) reliable indicator of renal glomerular function than creatinine.
Less
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.
incr
incr
Cystatin C
This low molecular weight peptide (13 kDa) is produced by _____________
all nucleated cells
Cystatin C
It is influenced by gender or muscle mass
may be increased in malignancy, hyperthyroidism
May be decreased by treatment with corticosteroids.
F (not)
T
F(incr)
What substance is better for GFR
Creatinine or Cystatin C
Cystatin C
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 ____________
unusual muscle bulk
Chronic kidney disease (CKD) is defined by the presence of __________ or ____________ for___________, irrespective of the cause.
kidney damage or reduced glomerular filtration rate (GFR)
three or more months
Ajie🖤?
Never
The morphological complication of hypertension on the kidney is _______ appearance
Flea bitten
