Chronic Kidney Disease

Question 0

Chronic kidney disease statistics (how many Americans have CKD and risk factors)

Answer 0

26 million Americans have CKD

Risk factors:

diabetes, one in three

Hypertension: one in five, CKD causes hypertension and hypertension causes CKD

Obesity
increasing age
family history

Question 1

Define chronic kidney disease and explain systemic and intrinsic factors for chronic kidney disease

Answer 1

Konicki need to seize-progressive loss of renal function

Due to systemic disease:
Diabetes
Hypertension
Systemic lupus Erythematosus

Due to intrinsic kidney disease:
Kidney stones
Injury
Chronic glomeruli nephritis

Question 2

How is kidney function measured

Answer 2

Kidney function is measured by glomular filtration rate

Estimated by creatinine clearance rate

Creatinine produced by muscles and excreted by kidneys

Measured in blood and urine

Question 3

List the five stages of GFR

Answer 3

Stage 1- normal= 90 ml/min or greater

Stage 2 -mild = 60 - 89 ml/min

Stage 3 -moderate = 30 -59 ml/min

Stage 4 -severe = 15-29 ml/min

Stage 5- end-stage renal disease = less then 15 ml/min

Question 4

Because the kidneys are extremely adaptable symptoms of failing kidneys are not often seen until GFR is =

Answer 4

25% or less of normal GFR

Question 5

List the pathophysiology of kidney damage

Answer 5

Injury to nephrons-loss of nephrons

Compensation by remaining nephrons-dilation of afferent and efferent arteriales
Afferent > efferent
Increased pressure in glomeruli 
Hyperfiltration
Mechanical stretch of cells
Inflammation

Injury to remaining nephrons

Progression of disease

Question 6

Explain diabetic Nephropathy

Answer 6

Advanced glycolytic end products (AG E)

• Products of nonenzymatic glycosylation
• can bind to basement membrane of glomerulous
• –alters functions of glomerulous
• –activate expression of cytokines

Hyperglycemia

-Sensitizes endothelial cells to injury

Question 7

In diabetic Nephropathy what is the significance of proteinurea

Answer 7

Glomerular injury leads to protein in protein activate inflammatory response

• Progressive damage to nephrons
• Increases proteinurea

Question 8

Explain lipid abnormalities in diabetic nephropathy

Answer 8

Animal models-hyper cholesterolemia worsens glomular injury and animals with decreased number of nephrons

Question 9

What is hypertensive nephropathy

Answer 9

Hyper filtration

Direct injury to the nephron

Promotion of arthrosclerosis in arterioles

• Ischemia
• Thrombosis

Question 10

What are the clinical manifestations of chronic kidney disease

Answer 10

Azotemia

Uremia-uremic syndrome

Hypertension

Protein urea

Acidosis

Skeletal changes

Disruption of nitrogen balance

Hyperinsulemia and insulin resistance

Dyslipidemia

Anemia

Question 11

Define Azotemia

Answer 11

Increased serum concentration of nitrogenous compounds due to decreased kidney function

Generally used when effects can be measured, but no symptoms

Question 12

Define uremia-uremic syndrome

Answer 12

Accumulation of nitrogen compounds and toxins

Severe Azotemia

Question 13

Clinical manifestations of hypertension

Answer 13

Poor excretion of sodium

Water retention

Increased blood pressure

Question 14

Clinical manifestations of proteinuria

Answer 14

Hypersecretion of protein in urine

Information nephrons

Further tissue destruction

Fibrosis scaring

Question 15

Clinical manifestations of acidosis

Answer 15

Kidney secrete excess hydrogen ions

May need to balance with alkali therapies or dialysis

Question 16

Skeletal changes due to kidney disease

Answer 16

Poor excretion of phosphorus

• Increase binding of Ca2 plus in the blood
• Decreased blood concentration of calcium

Increase secretion of parathyroid hormone

Release of calcium from bones

Brittle bones

Decreased vitamin D3 production by the kidneys poor absorption of calcium from food

Question 17

Clinical manifestations-metabolic disturbances that occur with chronic kidney disease

Answer 17

Disrupted nitrogen balance

-Hyperinsulemia- insulin resistance

Dyslipidemia

Question 18

Explain how anemia is a clinical manifestation of CKD

Answer 18

Kidneys produce erythropoetin

Stimulates production of RBCs

As kidney function decreases erythropoetin secreation decreases

Decreased production of RBCs

Decreased tissue oxygenation

Progression of CKD

Damaged heart and other organs

Question 19

CKD puts patients at higher risk for developing what

Answer 19

High risk of developing CVD

Arthrosclerosis, hypertension, Dyslipidemia, insulin resistance, major cause of MI and ischemia

CKD patients die of CVD illnesses:

• sudden cardiac death
• arrhythmia
• Congestive heart failure

Question 20

Explain uremic cardiomyopathy

Answer 20

Hypertrophy of the left ventricle

Hypertension and arthrosclerosis lead to pressure overload

Uremic State leads to production of factors that enhance LV hypertrophy

Parathyroid hormone, leptin, TNF alpha, IL-6

Hypertrophy may lead to dysfunction of tissues

• Dilation of LV
• Poor EF
• heart failure

Question 21

Treatment and prevention of CKD

Answer 21

Management and prevention of further progression: protein intake, salt water balance, potassium restriction, management of dyslipidemia, and vitamin D supplement, Reduction in blood pressure, dialysis, transplant

Question 22

ESRD has an average mortality rate of what

Answer 22

25%

Cardiovascular disease

Average life expectancy is C of six-year-old starting treatment for ESR D-3.9 years

Quality of life: sexual dysfunction, insomnia, fatigue, restless leg syndrome high medical costs, time spent on dialysis, relationship changes

Treatment with Ace inhibitors or Ace receptor blockers may prevent progression of the disease proteinuria