Chronic kidney disease Flashcards
How is chronic kidney disease defined?
It is defined as having a GFR of less than 60mls/min for atleast 3 months, without any evidence of kidney damage.
Or, it may be defined as evidence of kidney damage that causes renal pathology that may or may not decrease GFR.
With respect to CKD severity, what is the distribution like in Australia?
There are very few with severe, stage 5, end-stage CKD. Similarly, there are a lot of individual with hypertension or diabetes who are at risk of developing CKD one day.
What is the relationship between GFR and aging?
GFR naturally declines with increasing age.
What is the relationship between CKD patients and cardiovascular disease mortality?
Patients who have both CKD are more likely to die of CVD events than die because of kidney failure or from dialysis.
Is it possible for Diabetes sufferers to have CKD also, even though their kidneys are not excreting protein like most failing kidneys do?
Yes, that is exactly the case. 20-30% of diabetes sufferers do have CKD aswell but without proteinuria. The mechanism for this isn’t well understood.
Albumin is normally never excreted from the kidneys-except during end-stage kidney disease. Is the amount of proteinuria proportional to the severity of the kidney disease?
Yep. If albumin is being secreted, then this is ESKD- no one can save you then. But in general, the kidney will secrete more and more protein as it deteriorates.
Thus albuminuria is a strong indicator of kidney failure, but GFR is a strong indicator of morbidity and mortality.
What is the effect of inhibiting the renin-angiotensin system on patients with CKD?
This can be done by RAS inhibitor drugs. By inhibiting the renin-angiotensin system, there is decreased blood pressure to the renal arteries, which protects the failing kidneys from further damage. CKD patients are often prescribed this.
What is the effect of smoking on kidney function?
Smoking increases the risk of kidney damage. It increases proteinuria and decreases GFR.
What is the effect of lowering blood lipids on CKD?
None whatsoever. By lowering blood lipids there is no effect on CKD.
What is the relationship between phosphate and GFR?
As the GFR decreases, then phosphate retention increases. This is bad because normally, phosphates should be excreted. The increased phosphate levels in the blood go on to cause inhibition of vitamin D3 synthesis. Decreased vitamin D results in decreased Calcium absorption.
What is Calcium/phosphate disturbance and how does it affect CKD patients?
All late stage CKD patients will experience calcium-phosphate disturbance. This causes bone disease, calcification of blood vessels and premature death.
What is the relationship between CKD patient cholesterol levels and their survival rate?
Evidence suggests that patients with higher cholesterol levels have a much higher survival rate than those with low cholesterol. It is thought that it is not the cholesterol itself that protects, but rather that the cholesterol is an indicator of nutritional status and weight. So cholesterol levels proportional to body weight in CKD patients.
How does increased phosphate retention cause soft tissue calcification?
Increased blood levels of phosphate cause vascular calcification by increasing endothelial dysfunction.
