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BS - Renal System > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is the acronym for the functions of the kidney?

A

A - acid base balance

W - water removal
E - erythropoiesis
T - toxin removal

B - blood pressure control
E - electrolyte balance
D - vitamin D activation

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2
Q

How is the kidney involved in acid base balance?

A

It reabsorbs and produces bicarbonate

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3
Q

How is the kidney involved in water removal?

A

It produces urine

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4
Q

How is the kidney involved in erythropoiesis?

A

The kidney produces erythropoietin in the peritubular interstitial fibroblasts

This stimulates RBC production in bone marrow

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5
Q

How is the kidney involved in blood pressure control?

A

It is involved in the renin-angiotensin-aldosterone system

Renin is activated when blood pressure is low

This leads to Na+ and water retention that increases BP

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6
Q

What electrolytes are involved in electrolyte balance in the kidney?

A

sodium

potassium

chloride

magnesium

glucose

phosphate

bicarbonate

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7
Q

How is the kidney involved in Vitamin D activation?

A

It produces calcitriol

This promotes Ca2+ absorption in the gut and renal reabsorption of phosphate

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8
Q

What is involved in glomerular filtration?

A

The movement of substances from the blood within the glomerulus into the capsular space

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9
Q

What is involved in tubular reabsorption?

A

The movement of substances from the tubular fluid back into the blood

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10
Q

What is involved in tubular secretion?

A

The movement of substances from the blood into the tubular fluid

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11
Q

What is the main function of the glomerulus?

A

It filters small solutes from the blood

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12
Q

What is the main function of the Bowman’s capsule?

A

It collects what is filtered through the glomerulus

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13
Q

What is the main function of the proximal convoluted tubule?

A
  1. reabsorbs 65% of filtrate volume

(nutrients, ions and water)

  1. secretes toxins

(ammonia, creatinine, some drugs)

  1. adjusts filtrate pH
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14
Q

What is the main function of the descending limb of the loop of Henlé?

A

Water reabsorption through aquaporins

This increases osmolarity

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15
Q

What is the main function of the ascending limb of the loop of Henle?

A
  1. It reabsorbs Na and Cl

This reduces osmolarity

  1. Urea is secreted
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16
Q

What is the function of the distal convoluted tubule?

A

Aldosterone leads to reabsorption of Na+ (and Cl-) and secretion of K+

PTH causes Ca2+ reabsorption

It also reabsorbs bicarbonate and water and synthesises bicarbonate

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17
Q

What is the function of the collecting duct?

A

ADH leads to water reabsorption

It reabsorbs and secretes various ions to maintain blood pH

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18
Q

What does glomerular filtration rate refer to?

A

The ultrafiltrate of plasma which crosses the glomerular barrier into the urinary space

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19
Q

What is GFR equivalent to?

What is it used to measure?

A

It is equal to the total filtration rates of all functioning nephrons

It is a surrogate for the amount of functioning renal tissue

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20
Q

What is normal GFR?

A

90 mL/min/1.73 m^2 or higher

It cannot be measured directly and is adjusted for body surface area

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21
Q

What are the 2 different calculations that can be used to estimate GFR?

A
  1. CKD-EPI

2. MDRD

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22
Q

What is CKD-EPI based on?

When can it not be used?

A

It uses serum creatinine, sex, age and race

It cannot be used for children, pregnant women, elderly and some ethnic groups

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23
Q

What is the problem with MDRD calculations?

A

They underestimate GFR

CKD-EPI is a better predictor of risk

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24
Q

What must be taken into account when using formulae based on serum creatinine?

A
  1. higher average muscle mass in African patients means higher creatinine generation rate
  2. men have a greater muscle mass than women
  3. younger people have a greater muscle mass
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25
What is chronic kidney disease? How is it defined?
It describes abnormalities of kidney function or structure eGFR of less than 60 ml/min/1.73m2 must be present on at least 2 occasions 90 days apart
26
How many stages of chronic kidney disease are there? What are the GFR rates for each stage?
1. mild reduction - eGFR 60 - 89 2. mild to moderate reduction - eGFR 45-59 3. moderate-severe reduction - eGFR 30-44 4. severe reduction - eGFR 15-29 5. kidney failure - eGFR < 15
27
What is normal eGFR?
>90
28
What is CKD related to in terms of increasing risk of other conditions?
1. cardiovascular disease 2. acute kidney injury 3. falls and frailty 4. mortality It can progress to end-stage renal failure
29
What ethnic minorities are more affected by CKD?
South Asians and black people There are genetic factors
30
If someone has a eGFR of >60 ml/min, do they have CKD?
NO!! They only have CKD is there are other signs of kidney damage as well
31
What is the aetiology of CKD?
1. raised intraglomerular pressure 2. glomerulosclerosis 3. tubulointerstitial fibrosis 4. loss of renal cortex 5. shrunken kidneys
32
What is glomerulosclerosis?
Expansion of glomerular mesangium and deposition of extracellular matrix
33
What is tubulointerstitial fibrosis?
Tubular atrophy, interstitial inflammatory cell infilitrate and deposition of EC matrix in the interstitium
34
What conditions may people have that warrant a test for CKD?
1. diabetes 2. hypertension 3. acute kidney injury 4. CVD 5. detection of haematuria or proteinuria 6. chronic nephrotoxin use 7. family history of stage 5 kidney disease
35
If someone has CKD risk factors, what tests are carried out on them?
1. bloods and eGFR 2. urinalysis to look for blood/protein 3. blood pressure
36
What signs are seen in an unhealthy kidney?
1. fluid overload 2. elevated wastes - urea, creatinine, K+ 3. changes in hormone levels controlling BP, RBC production and calcium uptake
37
When do the symptoms of CKD tend to present?
It is generally asymptomatic in stages 1-3
38
What are the visible clinical manifestations of CKD?
1. vomiting 2. reduced urinary output 3. loss of lean body mass/muscle weakness 4. skin pigmentation 5. bleeding/bruising 6. loss of appetite, nausea, metallic taste
39
What are the non-visible clinical manifestations of CKD?
1. salt and water retention 2. aches and pains 3. lethargy, impaired immune function 4. sleep disturbance
40
What is uraemia?
This is the accumulation of toxins It involves a raised level in the blood of urea and other nitrogenous waste compounds
41
What are the symptoms of uraemia?
1. pericarditis 2. encephalopathy (impaired cognition, confusion, coma, seizures) 3. uraemic frost (urea and urate deposits on the skin)
42
What further investigations are performed to look for the underlying cause of CKD?
1. bloods 2. renal biopsy 3. imaging
43
What further investigations are performed to look for the complications of CKD?
1. blood count for anaemia 2. Ca2+, phos, ALP, vit D for renal bone disease 3. bicarbonate for metabolic acidosis
44
What further investigations are performed to look for the end-organ damage relating to complications of CKD?
ECG and echocardiogram
45
What further investigations are performed to look for the CV risk?
Lipid profile
46
When should a renal ultrasound scan be performed?
1. accelerated progression of CKD 2. visible or persistent invisible haematuria 3. symptoms of urinary tract obstruction 4. polycystic kidney disease and over 20
47
What are the non-modifiable factors influencing CKD progression?
1. underlying cause of kidney disease | 2. race
48
What are examples of modifiable factors influencing CKD progression?
1. dyslipidaemia 2. exposure to nephrotoxic agents 3. metabolic acidosis 4. anaemia 5. smoking 6. glycaemic control (diabetics) 7. blood pressure 8. level of proteinuria
49
What is the blood pressure aim for someone with CKD and ACR < 70?
Target BP < 140/90
50
What is the blood pressure aim for someone with CKD, DM and ACR >70?
Target BP < 130/80
51
When are ACEi or ARBs the first choice of treatment for high blood pressure in CKD?
Diabetic patients with hypertension or microalbuminuria Hypertensive patients with ACR >/= 30 mg/mmol All patients with ACR >/= 70 mg/mmol
52
What treatment is given for proteinuria?
ACE inhibitors or ARBs
53
What is the treatment for dyslipidemia?
Statins are given to patients over 50 They are given to patients <50 with risk factors for stroke, DM or CVD
54
What is hyperphosphataemia?
An electrolyte disorder in which there is an elevated level of phosphate in the blood
55
What is the risk of calcium phosphate deposition in hyperphosphataemia?
It can potentially lead to interstitial fibrosis and tubular atrophy
56
What is metabolic acidosis? What may it result in?
Increased acid secretion as the number of functioning nephrons decline It may result in complement activation and interstitial damage
57
Why are sodium bicarbonate supplements given in metabolic acidosis?
1. to buffer the acid 2. to prevent osteopenia 3. to prevent muscle wasting
58
What type of anaemia is present in CKD and why?
Normocytic anaemia It is due to an erythropoietin deficiency
59
What treatments are given for anaemia as a result of CKD?
1. erythropoiesis stimulating agents | 2. iron supplements
60
What are the 6 main complications of CKD?
1. anaemia 2. CKD mineral bone disorder 3. cardiovascular disease 4. volume overload 5. hyperkalaemia 6. malnutrition
61
What is the underlying cause of CKD-MBD?
Hyperphosphataemia leading from reduced renal clearance
62
What are the other contributing factors to CKD-MBD?
1. reduced renal hydroxylation of 25-hydroxyvitamin D 2. reduced calcium 3. secondary hyperparathyroidism
63
What are the treatments for CKD-MBD?
1. dietary restricition of phosphate and phosphate binders 2. 1a-hydroxylated analogues 3. calcimimetics 4. vitamin D replacement 5. parathyroidectomy
64
What is the role of 1a-hydroxylated analogues?
e.g. calcitriol They suppress PTH and control secondary hyperparathyroidism
65
What are the treatments for cardiovascular disease in CKD?
1. statins 2. antiplatelets 3. antihypertensives
66
What are the treatments for volume overload?
1. fluid and salt restriction 2. diuretics 3. renal replacement therapy
67
What must the ACR be for a patient to be referred for further treatment?
1. stage 4/5 CKD 2. ACR > 70 mg/mmol (not due to diabetes) 2. ACR > 30 mg/mmol plus haematuria
68
What must the GFR decrease be for someone to be referred for further treatment?
1. sustained decrease in GFR of >25% and a change in GFR category within 12 months 2. sustained decrease in GFR of > 15 ml/min/1.73m2 per year
69
What are the other factors that cause someone to be referred for further treatment?
1. raised BP despite 4 or more antihypertensives at therapeutic dose 2. known or suspected rare or genetic causes of CKD
70
What is involved in advanced CKD?
1. transplantation 2. haemodialysis 3. peritoneal dialysis 4. conservative management
71
What are the indications for renal replacement therapy?
1. uraemia 2. severe metabolic acidosis 3. hyperkalaemia 4. fluid overload

BS - Renal System (8 decks)

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