Chronic Kidney Disease Flashcards
What are the functions of the kidneys?
Body fluid homeostasis
Regulation of vascular flow
Excretory flow
Electrolyse homeostasis
Acid-base homeostasis
Endocrine function
Can glomerular filtration rate (GFR) be measured directly?
No
How can excretory renal function be measured?
Measure a substance in the blood that is only cleared by the kidneys e.g. serum creatinine
However, at which % of normal GFR does creatinine levels start to rise?
50% approx of normal GFR
How is creatinine generated?
Breakdown of muscle
What classification system in used to classify excretory kidney function using excretory GRF?
International CKD Classification System
Regarding the International CKD Classification System, what is meant by Stage 1?
Kidney damage but normal or high GFR >90 ml/min/1,73m2
->btw the 1.73/m2 is per squared meter of body or something
Regarding the International CKD Classification System, what is meant by Stage 2?
Kidney damage with a mild reduction in GFR
GFR = 60-89 ml/min/1.73m2
Regarding the International CKD Classification System, what is meant by Stage 3a/b?
Moderately impaired
What is the GFR for classification 3a?
45-59 ml/min/1.73m2
What is the GFR for classification 3b?
30-44 ml/min/ 1.73m2
Regarding the International CKD Classification System, what is meant by Stage 4?
Severely impaired
GFR= 15-29 ml/min/1.73m2
Regarding the International CKD Classification System, what is meant by Stage 5?
Advanced or on dialysis
GFR= <15 ml/min/1.73m2
One of the ways to asses kidney function, as well as seeing how much is excreted out, is seeing how much of the stuff required by the body is being kept in.
What can cross the glomerular basement membrane?
Electrolytes
Creatinine
One of the ways to asses kidney function, as well as seeing how much is excreted out, is seeing how much of the stuff required by the body is being kept in.
What can cross the glomerular basement membrane but gets reabsorbed in the proximal tubule?
Glucose
One of the ways to asses kidney function, as well as seeing how much is excreted out, is seeing how much of the stuff required by the body is being kept in.
What cannot cross the glomerular basement membrane?
Cells e.g. WBCs, RBCs
High molecular weight proteins e.g. albumin, globulins
Will there be any blood or protein in the urine if kidneys are filtering properly?
No
How can it be found if there is any blood or protein in the urine?
Urinalysis - dipstick
What is used to determine the protein quantification in urine?
Protein creatinine ratio
Give the definition of chronic kidney disease.
Either:
GFR <60ml/min/1.73m2
OR
the presence of kidney damage e.g. abnormal blood, urine or x-ray findings
THAT IS PRESENT FOR >3MONTHS
What is the most common cause of CKD?
Diabetes
Which imaging is used to detect causes of CKD?
Ultrasound
->non-invasive, no ionising radiation, may provide information about kidney size
What does a small kidney indicate?
Chronic problem as has shrivelled up over time
What is given to the patient for a kidney biopsy?
Local anaesthetic
What the most important factor in slowing the rate of renal decline?
BP control
Which drugs can be used to control proeinuria?
ACEi/ARBs
SGLT2 inhibitors
Okayyyy so
The kidneys have an endocrine function and has a role in the production of erythropoietin and vitamin D metabolism.
If the kidneys were damaged, what would the knock-on effect be on the endocrine function of the kidney?
Anaemia
Hypocalcaemia
Okayyyy so
The kidneys have a role in BP.
If the kidneys were damaged, what would the knock-on effect be on this function of the kidney?
Hypertension
Okayyyy so
The kidneys have a role in body fluid homeostasis and urine production.
If the kidneys were damaged, what would the knock-on effect be on this function of the kidney?
Fluid overload
Okayyyy so
The kidneys have a role in excretion of physiological waste e.g. urea.
If the kidneys were damaged, what would the knock-on effect be on this function of the kidney?
Uraemia
Drug toxicity
Okayyyy so
The kidneys have a role in electrolyte balance.
If the kidneys were damaged, what would the knock-on effect be on this function of the kidney?
Hyperkalaemia etc
Okayyyy so
The kidneys have a role in acid-base homeostasis.
If the kidneys were damaged, what would the knock-on effect be on this function of the kidney?
Acidosis
What is the main treatment for CKD?
Renal replacement therapy
