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IM > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Spectrum of pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR)

A

Chronic Kidney Disease

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2
Q

2 Broad Sets of Mechanisms of Damage in CKD

A
  1. initiating mechanisms specific to the underlying etiology

2. hyperfiltration and hypertrophy of the remaining viable nephrons

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3
Q

Risk Factors of CKD

A
  • small for gestation birth weight
  • childhood obesity
  • hypertension
  • diabetes mellitus
  • autoimmune disease
  • advanced age
  • African ancestry
  • a family history of kidney disease
  • a previous episode of acute kidney injury and presence of proteinuria
  • abnormal urinary sediment
  • structural abnormalities of the urinary tract
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4
Q

Normal annual mean decline in GFR with age from the peak GFR (~120 mL/min per 1.73 m2) attained during the 3rd decade of life

A

~1 mL/min per year per 1.73 m2

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5
Q

Refers to the excretion of amounts of albumin too small to detect by urinary dipstick or conventional measures of urine protein

A

Microalbuminuria

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6
Q

Serves as a marker not only for early detection of primary kidney disease, but for systemic microvascular disease as well

A

urinary albumin to creatinine ratio (UACR)

MEN - > 17 mg albumin/g creatinine
WOMEN - > 25 mg albumin/g creatinine

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7
Q

Devised to predict the risk of progression to stage 5 dialysis-dependent kidney disease

A

Kidney Failure Risk (KFR) equation

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8
Q

Factors affecting the likelihood and rate of CKD progression

A

baseline eGFR and degree of albuminuria
primary renal disease
ongoing exposure to nephrotoxic agents
others: obesity, hypertension, age, ethnicity and laboratory parameters

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9
Q

Stage of CKD where the accumulation of toxins, fluid, electrolytes normally excreted by the kidney –> uremic syndrome

A

ESRD

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10
Q

Etiologies of CKD

A 
Diabetic nephropathy
Glomerulonephritis
HPN associated CKD
ADPKD
Other cystic and tubulointerstitial nephropathy
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11
Q

Major risk factor for cardiovascular disease

A

Minor decrement in GFR or the presence of albuminuria

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12
Q

PATHOPHYSIOLOGY OF UREMIC SYNDROME (3 Spheres Of Dysfunction)

A
  1. accumulation of toxins that normally undergo renal excretion
  2. loss of other kidney functions such as fluid and electrolyte homeostasis and hormone regulation
  3. progressive systemic inflammation and its vascular and nutritional consequences
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13
Q

May serve as an indication to initiate dialysis in advanced CKD

A

diuretic resistance with intractable edema and hypertension

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14
Q

Common disturbance in advanced CKD – metabolic acidosis

A

NAGMA – early stage

HAGMA – later stage

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15
Q

Used to maintain euvolemia in CKD

A

dietary salt restriction and loop diuretics + metolazone

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16
Q

Treatment of hyperkalemia in CKD

A

dietary restriction of potassium
Kaliuretic diuretics
potassium-binding resins – calcium resonium, sodium polystyrene or patiromer

17
Q

Considered a uremic toxin and high levels are associated with muscle weakness, fibrosis of cardiac muscle, and nonspecific constitutional symptoms

A

parathyroid hormone

18
Q

Leading cause of morbidity and mortality in patients at every stage of CKD

A

cardiovascular abnormalities

19
Q

Cardiovascular abnormalities

A

Ischemic Vascular Disease
Heart Failure
Hypertension and Left Ventricular Hypertrophy
Pericardial Disease

20
Q

For the CKD patient not yet on dialysis or the patient treated with peritoneal dialysis

A

oral iron supplementation

21
Q

Subtle clinical manifestations of uremic NEUROMUSCULAR disease usually become evident at

A

stage 3 CKD

22
Q

PERIPHERAL NEUROPATHY becomes clinically evident after the patient reaches

A

stage 4 CKD

23
Q

EARLY MANIFESTATIONS OF CNS COMPLICATIONS:

A

mild disturbances in memory and concentration and sleep disturbance

24
Q

LATER STAGES:

A

neuromuscular irritability – hiccups, cramps, and twitching

25
Q

ADVANCED UNTREATED KIDNEY FAILURE

A

asterixis
myoclonus
seizures
coma

26
Q

Characterized by ill-defined sensations of sometimes debilitating discomfort in the legs and feet relieved by frequent leg movement

A

“restless leg syndrome”

27
Q

Urine-like odor on the breath, derives from the breakdown of urea to ammonia in saliva and is often associated with an unpleasant metallic taste (dysgeusia)

A

uremic fetor

28
Q

Quite common and one of the most vexing manifestations of the uremic state

A

pruritus

29
Q

Skin condition unique to CKD patients which consists of progressive subcutaneous induration, especially on the arms and legs

A

nephrogenic fibrosing dermopathy

30
Q

Diagnosis of CKD of long-standing duration

A

bilaterally small kidneys

EXCEPTION:
diabetic nephropathy
amyloidosis
HIV nephropathy
polycystic kidney disease
31
Q

COMMONLY ACCEPTED CRITERIA FOR INITIATING PATIENTS ON MAINTENANCE DIALYSIS

A

• presence of uremic symptoms
nausea, vomiting, anorexia
altered mental status – lethargy, somnolence, malaise, stupor, coma, delirium
pericarditis
friction rub
chest pain
dyspnea
bleeding diathesis
uremic encephalopathy – asterixis (flapping tremor of the hand), tremor multifocal myoclonus, seizures
uremic fetor (breath smells like urine)
sallow skin (slightly yellow and/or slightly pale)

  • presence of hyperkalemia unresponsive to conservative measures
  • persistent extracellular volume expansion despite diuretic therapy
  • acidosis refractory to medical therapy
  • bleeding diathesis
  • creatinine clearance or estimated glomerular filtration rate (GFR) <10 mL/min per 1.73 m2)
32
Q

Relies on the principles of solute diffusion across a semipermeable membrane, movement of metabolic waste products takes place down a concentration gradient from the circulation into the dialysate

A

Hemodialysis

33
Q

3 essential components to hemodialysis

A

dialyzer
composition and delivery of the dialysate
blood delivery system

34
Q

Have the highest long-term patency rate of all hemodialysis access options

A

Fistula

35
Q

The most common additives to peritoneal dialysis solutions

A

heparin

36
Q

dialysis access is the preferred option if your veins are too small

A

AV graft

37
Q

Absolute Indications for Renal Replacement Therapy

A

Pericarditis or Pleuritis

Progressive Uremic Encephalopathy or neuropathy w/ signs such as confusion, asterixis, myoclonus, wrist or foot drop, seizures

Bleeding diathesis attributable to uremia

Persistent metabolic disturbances that are refractory to medical therapy - hyperkalemia, metabolic acidosis, hypercalcemia, hypocalcemia and hyperphosphatemia

Fluid overload refractory to diuretics

HPN poorly responsive to antiHPN medications

Persistent nausea and vomiting

Evidence of malnutrition

38
Q

Relative Indications for Renal Replacement Therapy

A

anorexia and nausea

impaired nutritional status

increased sleepiness

decreased energy levels, attentiveness and cognitive tasking

39
Q

Indication for Maintenance Dialysis

A

Uremic Symptoms - N/V, loss of consciousness, uremic pericarditis
Intractable HYPERKALEMIA
Persistent Volume Expansion despite Diuretics
Refractory ACIDOSIS
Bleeding Diasthesis
eGFR < 1.73 mL

IM (66 decks)

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