Chronic Kidney Disease

Question 1

CKD is defined as

Answer 1

permanent reduction in GFR

Question 2

Stage 1 CKD
Description
GFR
Action

Answer 2

Kidney damage, normal GFR
GFR > 90
Diagnose and treat

Question 3

Stage 2 CKD
Description
GFR
Action

Answer 3

Kidney damage, mild decr GFR
GFR 60-89
Estimate progression

Question 4

Stage 3 CKD
Description
GFR
Action

Answer 4

Moderate decr GFR
GFR 30-59
Treat complications

Question 5

Stage 4 CKD
Description
GFR
Action

Answer 5

Severe decr GFR
GFR 15-29
Prepare for renal replacement

symptomatic

Question 6

Stage 5 CKD
Description
GFR
Action

Answer 6

Kidney failure

Question 7

Most common causes of CKD

Answer 7

1) diabetic nephropathy
2) hypertensive nephrosclerosis and renal vascular disease
3) glomerulonephritis
4) polycystic kidney disease

Question 8

as serum creatinine, incr

Answer 8

exponential decline in creatinine clearance

Question 9

Intact nephron hypothesis

Answer 9

nephrons still maintain glomerulotubular balance

filtration = net excretion

Question 10

Magnification phenomenon

Answer 10

nephrons maintain external balance of solutes = magnify excretionof given solute

Question 11

Individual solute control system

Answer 11

each solute has individual tubular handling and hormonol influences

Question 12

trade off hypothesis

Answer 12

incr PTH in CKD to maintain serum calcium and incr renal phop excretion

Question 13

With decr GFR, creatinine and urea ___

Answer 13

balance is maintained (rate of filtration) so the excretion rates are constant

Question 14

With CKD, water

Answer 14

reabs decr
flow per nephron incr
–> hypoosmolarity

Question 15

urine concentrating ability fixed around

with dehydration and low water intake

Answer 15

300 mOsm/kg

susceptible to dehydration

prone to water excess (hyponatremia) and water deficiency (hypernatremia)

Question 16

why does nocturia occur in CKD

Answer 16

inability to concentrate urine at night

Question 17

with CKD if you have incr sodium intake what happens

if you have incr extrarenal loss

Answer 17

edema

volume depletion

Question 18

with CKD how does potassium regul change

Answer 18

decr tubular secretion of potassium

usu normal K+ with normal diet but incr K+ diet–> hyperkalemia

Question 19

with CKD how does H+ regul change

Answer 19

nephrons produce more NH4+ to compensate for loss nephrons

until GFR too much retained H+ titrates down HCO3- –> non-anion gap metab acidosis

Question 20

Uremia means

Answer 20

retaining substances in blood that are normally excreted

Question 21

reasons for uremia syndrome

Answer 21

1) overproduction of PTH due to hypocalcemia and ANP

2) decr EPO production
3) decr 1-hydroxylation of vitamin D

Question 22

why does anemia occur when GFR

Answer 22

1) EPO decr, lower end-organ response to EPO
2) blood loss, decr platelet function
3) decr RBC survival

Question 23

why does HTN occur in mild CKD

Answer 23

1) too much retained Na and H2O
2) incr renin
3) incr symp tone
4) decr vasodilators

Question 24

trade off hypothesis of mineral bone disease of CKD

Answer 24

1) kidney fails
2) phosphorous retained
3) decr Ca2+
4) stim PTH
5) excrete phosphorous

over time, decr GFR, incr PTH –> hyperphosphatemia and hypocalcemia and bone disease

Question 25

Calcium effect on PTH in CKD

Answer 25

1) incr calcium
2) bind to receptor
3) decr PTH

normally PTH reabsorbs calcium

Question 26

1,25 vitamin D effect on PTH and phsophorous

Answer 26

1) FGF-23 decr 1,25 vitamin D and decr GFR decr 1,25 vitamin D
2) decr gut phosphorous reabs

Question 27

normal fxn of 1,25 vitamin D

Answer 27

1) abs of Ca and phosph

2) downregulate PTH