Chronic Kidney Disease Flashcards
How long does kidney dysfunction have to last before a diagnosis of CKD is made?
1 - >2 weeks
2 - >4 weeks
3 - >8 weeks
4 - >12 weeks
4 - >12 weeks
- >3 months
A reduced eGFR and albuminuria that occur in CKD are associated with:
- all cause mortality
- CVD mortality
- progressive kidney disease
- AKI
Are patients with CKD more likely to die from CVD or due to the need for renal therapy?
- CVD
In CKD patients can experience:
- loss of appetite
- nausea
- vomiting
- encephalopathy
- headaches
- blurred vision
- pericarditis
What is the primary call for all of these symptoms?
1 - dehydration
2 - uraemia
3 - anaemia
4 - hyponatraemia
2 - uraemia
- essentially build up of toxins in the blood of urea
- ammonia produced from amino acid metabolism can also be high and cause these symptoms
- ammonia is converted to urea in kidney
What is the primary reason for anaemia in CKD?
1 - haematuria
2 - insufficient anti- coagulant proteins causing bleeding
3 - high levels of erythropoietin
4 - low levels of erythropoietin
4 - low levels of erythropoietin
- erythropoietin stimulates bone marrow to make more RBCs
In CKD which of the following is most common?
1 - microcytic anaemia (<80fl)
2 - normlcytic anaemia (80-100fl)
3 - macrocytic anaemia (>100fl)
4 - mixture of all of them
2 - normlcytic anaemia (80-100fl)
- the production is normal, BUT there is less of the RBCs
There are a myriad of complications caused by CKD. Which one of these occurs?
1 - hypercalcaemia
2 - hyperkalaemia
3 - hypernatraemia
4 - hyperphosphatemia
2 - hyperkalaemia
- can cause cardiac arrhythmias
- ECG changes tall peaked T waves, increased PR interval, small/absent P wave and widened QRS complex
How can CKD cause weak and brittle bones?
1 - unable to activate vitamin D
2 - re-absorbs too much Ca2+
3 - uraemia inhibits PTH release
4 - all of the above
1 - unable to activate vitamin D
- Ca2+ is not re-absorbed as well, no increase in Ca2+ absorbed from GIT
- PTH is released to increase Ca2+ from bone
- over time this causes renal osteodystrophy
Why can CKD result in hyperventilation?
1 - low HCO3-
2 - hyperkalaemia
3 - metabolic acidosis
4 - all of the above
4 - all of the above
- hyperkalaemia causes metabolic acidosis
- HCO3- is insufficient to compensate
- lungs remove CO2 in an attempt to reduce pH, causing hypocapnia
Which of the following is NOT associated with causing CKD?
1 - PPIs
2 - anti-depressants
3 - NSAIDs
4 - Lithium
2 - anti-depressants
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. Which 2 of the following are used in determining the stage of CKD?
1 - creatinine
2 - eGFR
3 - albumin
4 - glucose
2 - eGFR
3 - albumin
- in urine its called albuminuria
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Based on the patients eGFR, CKD can be staged between G1-G5. What is the definition of stage G1?
1 - 15-29
2 - >90
3 - <15
4 - 60-89
5 - 45-59
6 - 30-44
2 - >90
- normal or high eGFR
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Based on the patients eGFR, CKD can be staged between G1-G5. What is the definition of stage G2?
1 - 15-29
2 - >90
3 - <15
4 - 60-89
5 - 45-59
6 - 30-44
4 - 60-89
- mildly decreased
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Based on the patients eGFR, CKD can be staged between G1-G5. What is the definition of stage G3a?
1 - 15-29
2 - >90
3 - <15
4 - 60-89
5 - 45-59
6 - 30-44
5 - 45-59
- mildly to moderately decreased
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Based on the patients eGFR, CKD can be staged between G1-G5. What is the definition of stage G3b?
1 - 15-29
2 - >90
3 - <15
4 - 60-89
5 - 45-59
6 - 30-44
6 - 30-44
- moderately to severely decreased
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Based on the patients eGFR, CKD can be staged between G1-G5. What is the definition of stage G4?
1 - 15-29
2 - >90
3 - <15
4 - 60-89
5 - 45-59
6 - 30-44
1 - 15-29
- severely decreased
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Based on the patients eGFR, CKD can be staged between G1-G5. What is the definition of stage G5?
1 - 15-29
2 - >90
3 - <15
4 - 60-89
5 - 45-59
6 - 30-44
3 - <15
- kidney failure
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Albuminuria can be used to stage the severity of CKD between A1-A3. What is the albumin cutoff for stage A1?
1 - 30-330mg/g/24h (3-30mg/mmol)
2 - <30mg/g/24 (<3mg/mmol)
3 - >300mg/g/24h (>30mg/mmol)
2 - <30mg/g/24 (<3mg/mmol)
- normal to mildly increased
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Albuminuria can be used to stage the severity of CKD between A1-A3. What is the albumin cutoff for stage A2?
1 - 30-330mg/g/24h (3-30mg/mmol)
2 - <30mg/g/24 (<3mg/mmol)
3 - >300mg/g/24h (>30mg/mmol)
1 - 30-330mg/g/24h (3-30mg/mmol)
- moderately increased
CKD is when there is an abnormality in kidney structure and function for >3 months that has implications of affecting a patients health. eGFR and albumin are used to stage CKD. Albuminuria can be used to stage the severity of CKD between A1-A3. What is the albumin cutoff for stage A3?
1 - 30-330mg/g/24h (3-30mg/mmol)
2 - <30mg/g/24 (<3mg/mmol)
3 - >300mg/g/24h (>30mg/mmol)
3 - >300mg/g/24h (>30mg/mmol)
- severely increased
In addition to measuring albumin over 24h, we can also look at the albumin levels when compare to what other marker of kidney damage?
1 - blood
2 - glucose
3 - creatine
4 - creatinine
4 - creatinine
- easier than measuring albumin alone
- requires just a snapshot
Below are albumin:creatinine ratios:
A1 = <3
A2 = 3-30
A3 = >30
What is the most common cause of CKD?
1 - hypertension
2 - diabetes
3 - glomerulonephritis
4 - other causes
5 - idiopathic
2 - diabetes
- both type 1 and 2 diabetes can cause this
- glomerulonephritis = essentially nephritic syndrome
Does CKD increase with age?
- yes
- kidney function naturally declines with age
Hperglycaemia can lead to glucose binding with proteins and molecules in the blood. What is this process called?
1 - enzymatic glycation
2 - non-enzymatic glycation
3 - glycoselation
4 - glucosurinaemia
2 - non-enzymatic glycation
- leads to binding with proteins and lipids in the blood, endothelium and other tissues throughout the body
Hperglycaemia can lead to glucose binding with proteins and lipids in the blood and tissues, called non-enzymatic glycation. Which of the following does this NOT typically cause?
1 - creates anti-inflammatory molecules
2 - increases LDL in blood causing atherosclerosis
3 - hyaline atherosclerosis causing a thickening of the basement membranes
4 - reduces gas exchange at basement membrane, leading to thickening
1 - creates anti-inflammatory molecules
- creates very pro-inflammatory molecules
Diabetes is the leading cause of CKD, and is linked with non-enzymatic glycation (due to hyperglycaemia) that causes hyaline atherosclerosis, a thickening of the basement membranes. In relation to the kidney where does this affect 1st?
1 - narrows efferent arterioles
2 - dilation afferent arterioles
3 - mesangial cells of glomerulus
4 - juxtaglomerular cells
1 - narrows efferent arterioles
- means blood cannot leave glomerulus
- afferent arteriole dilates to help but together causes hyperfiltration
Diabetes is the leading cause of CKD. Which of the following is NOT an affect that leads to CKD in patients with diabetes?
1 - non-enzymatic glycation (due to hyperglycaemia) that causes hyaline atherosclerosis
2 - narrowing of afferent arteriole
3 - increased pressure within the glomerulus
4 - mesangial cells secrete ECM to increase glomerular size to assist filtration
5 - ECM leads to glomerular sclerosis and reduces eGFR
2 - narrowing of afferent arteriole
- can occur, but typically it is the efferent arteriole affected, which makes it harder for blood to leave glomerulus
In diabetic nephropathy mesangial cells are stimulated and secrete ECM, which increases the size of the glomerulus to assist with filtration. Instead of assisting with filtration, what can this process do to the basement membrane?
1 - become thin and become weak
2 - damaged and form blood clots
3 - thickens and podocyte foot processes spread-out
4 - all of the above
3 - thickens and podocyte foot processes spread-out
- increases permeability to proteins and glucose
- eGFR declines
Hypertension can cause CKD. Which of the following is NOT an affect that leads to CKD in patients with hypertension?
1 - renal arteries dilate
2 - glomerular ischaemia
3 - macrophages and foam cells enter glomerulus and secrete TGF-B1
4 - TGF-B1 induces mesangial cell regression to mesoangioblasts
5 - mesoangioblasts secrete ECM causing glomerular sclerosis (scarring)
6 - glomerular sclerosis reduces ability of glomerulus to filter
1 - renal arteries dilate
- renal arteries become stiff and thicken, reducing renal blood flow
- macrophages and foam cells are common in atherosclerosis, common cause of high BP
Which of the following is the most commonly inherited cause of CKD?
1 - Alport syndrome
2 - Polycystic kidney disease
3 - Gitelman syndrome
4 - Good Pasteurs Syndrome
2 - Polycystic kidney disease
- autosomal dominant (non-sex chromosome)
- kidneys become filled with 100s of fluid filled sacs
Polycystic kidney disease (PKD) is the most commonly inherited cause of CKD and causes 100s of fluid filled cysts to form in BOTH kidneys. What is the most common mutation that causes PKD?
1 - PKD 1
2 - PKD 2
3 - PKHD1
4 - P53
1 - PKD 1