Chronic Kidney Disease

Question 1

A
WET
BED

Answer 1

acid base balance

water removal
erythropesis
toxin removal

blood pressure control
electrolyte balance
vitamin d activation

Question 2

how does the kidney affect acid base balance

Answer 2

reabsorb and produce bicarbonate

Question 3

how does the kidney stimulate RBC production

Answer 3

produces EPO which goes to the bone marrow

Question 4

how in summary do the kidneys contra BP

Answer 4

RAAS
if BP low then renin activated and a series of actions leading to reabsorption of sodium and chloride and thus water increasing bP

Question 5

how do the kidneys affect vit d

Answer 5

calcitriol which promotes Ca absorption in the gut and renal absorption of phosphate

Question 6

describe the basic physiology of the limbs within the nephron

Answer 6

check photos

Question 7

describe the process of urea cycling

Answer 7

urea diffuses out of the collecting duct into the loop of henle to help maintain osmotic gradient

Question 8

what would a reduction in GFR be due to

Answer 8

reduction in number of nephrons

reduction in single nephron GFR

Question 9

what are the uses of measure GFR

Answer 9

measure of kidney function and monitor progression of CKD

Question 10

how does ethnicity affect GFR

Answer 10

african patients have higher creatinine clearance so shows higher GFR at same level of sCr

Question 11

what is the definition of CKD

Answer 11

all individuals with markers of kidney damage or those with an eGFR of less than 60 ml/min/1.73m2 on at least 2 occasions 90 days apart (with or without markers of kidney damage).

Question 12

what is chronic kidney disease commonly associated with

Answer 12

hypertension, DM, vascular disease, age

certain ethnic minorities

Question 13

what are some causes of CKD

Answer 13

diabetes 
glomerular disease
hypertension
infection 
multiple myeloma 
urinary tract infection 
alport syndrome

Question 14

what is the aetiology of CKD (causes)

Answer 14

raised intra-glomerular pressure 
glomerulosclerosis - expansion of glomerular magnesium and deposition of ECM 
tubulointerstitial fibrosis 
loss or renal cortex 
shrunken kidneys

Question 15

what happens to structure and function of the kidney as you get older

Answer 15

renal mass declines
reduces glomeruli number
decreased renal blood flow

Question 16

how do you test for CKD

Answer 16

first if they have the normal risk factors

then test for eGFR, urinalysis for blood/protein, blood pressure

Question 17

what is the problem with detecting CKD

Answer 17

stages 1-3 are generally asymptomatic

Question 18

what are the characteristics of mineral bone disease due to CKD

Answer 18

high phosphate, low calcium, high PTH, low bicarbonate, low vit D

Question 19

what is uraemia

Answer 19

accumulations of toxins and urea in the body
symptoms - pericarditis, encephalopathy, uraemic frost, restless legs
nausea, vomiting, reduced appetite

Question 20

how does smoking affect CKD

Answer 20

increases proteinuria and progression

Question 21

why does hypertension increase progression of CKD

Answer 21

increased glomerular filtration pressure = proteinuria = renal injury

Question 22

what types of medications can be used to reduce proteinuria

Answer 22

ACEi and ARBs

Question 23

why should you not give ARBs and ACEi’s at the same time

Answer 23

hyperkalaemia

hypotension

Question 24

describe the process of metabolic acidosis in CKD

Answer 24

not enough ammonia in prox tubules to excrete the endogenous acid into the urine in the form of ammonium.

Question 25

what physiological issues come with metabolic acidosis

Answer 25

Bone acts as a buffer for excess acid=Increased bone resorption and impaired mineralization=renal osteodystrophy
Muscle weakness, fatigue,
Hyperkalaemia- h/k exchange in collecting duct
Malnutrition- acidosis promites catabolism i.e. muscle wasting(by induction of proteolysis and resistance to growth hormones=malnutrition)

Question 26

when would you see anaemia in CKD

Answer 26

rare before CKD3b

Question 27

summary the complications of CKD

Answer 27

anaemia 
CKD-MBD
cardiovascular disease 
volume overload 
hyperkalaemia 
malnutrition

Question 28

what happens during CKD mineral bone disorder

Answer 28

hyperphosphataemia
reduced renal hydroxylation of vit D
reduced calcium
secondary hyperparathyroidism

Question 29

what is the treatment of CKD mineral bone disorder

Answer 29

phosphate - dietary restriction, phosphate binders (calcium acetate, lanthanum) 
calcitriol 
calcimimetics eg cinacalcet
vit D replacement 
parathyroidectomy

Question 30

what are 4 indication son RRT

Answer 30

uraemia
severe metabolic acidosis
hyperkalaemia
fluid overload