Chronic kidney disease Flashcards

Question

Glucose - osmotic agent

Answer 1

cheap, easy, non-toxic Bad: small, rapidly absorbed, metabolized (caloric load) induces fibrosis & inflammation of peritoneal membrane

Answer 2

Good: higher osmotic effect (charged), equivalent to glucose in solute drag and ultrafiltration equivalent, absorbed Bad: appetite suppression, metabolic acidosis, urea increases, effects on membrane haven't shown to be very effective

Answer 3

glucose polymer, induce colloid osmotic effect Good: only slightly absorbed (10-20% over 8 hours), prolonged ultrafiltration, colloid osmosis, equivalent solute clearance, lower caloric load Bad: unsure about effects of high maltose

Answer 4

persistent (>3mth) abnormal kidney function due to intrinsic disease of kidneys OR normal function but persistent structural/functional abnormality of kidneys with markers for kidney damage (proteinuria, hematuria)

Answer 5

``` diabetes HTN ischemic/vascular Glomerular (nephrotic, nephritic) PCKD drug-induced pyelonephritis Reflux ```

Answer 6

``` persistence of underlying disease HTN hemodynamic injury to kidney proteinuria nephrotoxic injury male degree of scarring on renal biopsy prior AKI ``` ``` Refer to nephrologist: GFR<30 acute renal failure progressive loss of GFR by 10ml/min/yr persistent significant proteinuria ```

Answer 7

``` diabetes HTN atherosclerosis, vascular disease FHx high risk ethnicity: first nations, S. asian, pacific inlander Other: age, unexplained anemia, CHF ``` Consider reversible factors (vol depletion, obs, NSAIDs, illness) Need to do repeat measurements, once confirmed: PE, urinanalysis/urine protein, renal US

Answer 8

Stage 5 - kidney failure, GFR < 15 severe 4 - 15-29 moderate 3 - 30-59 Recently: include albuminuria macroalbuminuria: male > 25, female >35 microalbuminuria: male 2.5-25, female 3.5-35 macroalbuminuria = very high risk for complications

Answer 9

see HTN at all stages, CVD most stages Anemia start to see at <30 , 30-59 mild Neuropathy/malnutrition at later stages

Answer 10

``` lifestyle target: 140/90 non-diabetic, 130/80 diabetic 1st line: ACEi OR ARB (NO COMBINATION) 2nd: diuretic - thiazide if GFR > 30 - loop if GFR < 30 - spironolactone - effective but risk of hyperkalemia 3rd: long-acting CCB (DHP/non-DHP) ``` better outcome with ACEi + CCB rather than ACEi + diuretic

Answer 11

``` fatigue cold intolerance nausea anorexia pruritus restless legs, leg cramps constipation edema SOB pulmonary edema reduced urine output reduced sexual drive ED change in mental status ```

Answer 12

small, non-N compounds: phosphate, cresol, phenylacetic acid small N compounds: guanidines, spermidine, indoxyl sulphate, homocysteine Middle molecules: beta-2 microglobulin, cytokines, complement factor D, advanced glycation end products, advanced oxidation protein products

Answer 13

Lp x SA x [(Pgc - Pbs) - s(pigc - pibs)] Lp = permeability of capillary wall SA = surf area available for filtration s = reflection coefficient for proteins across capillary wall (0- completely permeable; 1 = completely impermeable)

Answer 14

neonates ~40 2-12 yrs ~130 13-21: ~140 (male), ~120 (female) after 20-30, normal GFR decreases 0.5-1 ml/min/1.73m2 per yr

Answer 15

``` GFR = UxV/(PxT) U = [urine] of indicator V = urinary volume P = [plasma] of indicator T = time ```

Answer 16

``` constant production readily diffuses through EC space freely filtered, not protein-bound no tubular reabsorption no tubular secretion no extrarenal elimination/degradation does not influence GFR cheap, convenient, easily measured ``` Inulin - gold standard, not easily measured

Answer 17

rarely performed requires iv infusion of inulin not available in most laboratories needs iv infusion of inulin

Answer 18

``` produced endogenously proportional to muscle mass constant throughout day freely filtered at glomerulus convenient and inexpensive ```

Answer 19

widely used yet inaccurate variability between individuals muscle mass can change can be altered by increased creatine and creatinine consumption extra renal elimination: intestinal bacteria - significant in renal dysfunction secreted by tubules - increases with declining kidney function, overestimation of kidney function

Answer 20

non-linear when nephrons are lost, compensatory hyperfiltration of other nephrons as GFR falls, increase in tubular secretion of creatinine

Answer 21

24 hr urine, measure volume and [creatinine], and blood [creatinine] Pros: don't worry about muscle mass and extrarenal creatinine elimination Cons: not the same as true GFR - still tubular secretion - cumbersome collection process Uses: no often used for assessment of renal function assess proteinuria assess electrolyte excretion

Answer 22

Radiolabelled indicator filtered at glomerulus -5-10% bound by protein, slight underestimation of GFR -20% cleared with each pass through kidney Serial imagining of kidneys with gamma ray counter cons: inconvenient used when accurate measurement of GFR is essential (transplant)

Answer 23

use demographic & clinical info to predict GFR Pros: preferred method of GFR estimation. more variables, not dependent on urine collection Cons: rely on individual being at steady state, not always at avg state in population, still affected by tubular secretion/extrarenal elimination

Answer 24

estimation of creatinine clearance (overestimate GFR) Cr clearance = [(140-age) x weight] / (serum creatinine x 50) x0.85 women x 60 for ml/min creatinine = umol/L weight kg

Answer 25

estimates GFR

Answer 26

eGFR | more accurate in people with normally/mildly reduced renal function

Answer 27

LMW protein freely filtered at glomeruli but metabolized by renal tubules maybe more accurate in certain populations