Chronic Kidney disease CIS

Question 1

Why don’t we use GFR to find a stage of acute kidney injuries?

Answer 1

there is no steady-state creatinine level; it must be stable

Question 2

nephrotic syndrome has what symptoms

Answer 2

hyperlipidemia
hypercoagulability
high protein
low albumin (less than 3)
low vitamin D
low zinc and copper

peri-orbital edema

increased platelet aggregation

Question 3

mainstay of treatment for nephrotic syndrome?

Answer 3

contrl blood sugars and blood pressures

ACEI or ARB

Question 4

Nephritic syndromes

Answer 4

post infectious glomerulonephritis
IgA nephropathy (Berger)

Question 5

Extrarenal presentations and blood test: Post infectious GN

Answer 5

look for hematuria 1-3 wks after infection. blood test will show positive ASO and decreased complement

Question 6

Extrarenal presentations and blood test: IgA nephropathy (Berger)

Answer 6

hematuria 1-2 days onset of acute infection, no diagnostic blood test

Question 7

Extrarenal presentations and blood test: Henoch Schoenlein purpura

Answer 7

palpable purpura LE and buttocks, arthralgias; nausea, colic and melena. no diagnostic blood test

Question 8

Extrarenal presentations and blood test: goodpasture syndrome

Answer 8

After URI, hemoptysis, pulmonary infiltrates,

anti-GBM antibodies

Question 9

Extrarenal presentations and blood test: MPGN and C3 glomerulopathies

Answer 9

nothing but renal failure

blood test: decreased C3 complement

Question 10

Extrarenal presentations and blood test: microscopic polyangiitis

Answer 10

fever, weight loss, rash, myalgia/ arthralgia/ neuropathy and symptoms specific to affected system.

blood test: C-anca (Pr3) or p-anca (MPO)

Question 11

Extrarenal presentations and blood test: eosinophilic granulomatosis with polyangiitis (Churg Strauss disease)

Answer 11

asthma, paranasal sinusitis, transient pulmonary infiltrates, neuropathy

blood test: c-Anca , peripheral blood eosinophilia over 10%, elevated serum IgE levels, hypergammaglobulinemia, elevated levels of eosinophil cationic protein
basically, all the signs of allergies

Question 12

Extrarenal presentations and blood test: Granulomatosis with Polyangiitis (wegener’s granulomatosis)

Answer 12

chronic sinusitis, pulmonary infiltrates (hemoptysis), arthralgia

blood test: c-anca

Question 13

Extrarenal presentations and blood test: cryoglobulin associated glomerulonephritis

Answer 13

purpuric and necrotizing skin lesions, arthralgias, fever and hepatosplenomegaly

blood test: hep c antibody, false positive rheumatoid arthritis, decreased complement

Question 14

Extrarenal presentations and blood test: SLE

Answer 14

malar rash, arthralgia, multi-system involvement

blood test: ANA, double-stranded dna antibodies, decreased serum C3, C4, CH50

Question 15

uremic signs and symptoms

Answer 15

fatigue, weakness
pruritus, bruisability, pallor, excoriations, edema, xerosis
metallic taste in mouth, epistaxis, uremic breath
shortnes of breath, rales, pleural effusion
dyspnea on exertion, retrosternal pain on inspiration (pericarditis), hypertension, cardiomegaly, friction rub
anorexia, nausea, vomiting, hiccups
nocturia, ertectile dysfunction
stupor, irritability, death

Question 16

High BUN and platelet aggregation

Answer 16

frequent bruising
bad periods
nosebleeds

Question 17

Renal Replacement therapy

Answer 17

renal transplant- treatment of choice if no contraindications, subject to graft availability. More cost-effective than dialysis. Requires immunosupplessive therapy
contraindications: metastatic cancer, ongoing or recurring infections not effectively treated,serious cardiac or peripheral vacular disease, liver failure- unless double transplant, low life expectancy, demonstrated medical noncompliance or inability to perform rehabilitation, out of control HIV infection

Hemodialysis- AV fistula ofr easy access for needle, enlarged vein is able to receive blood

Peritoneal dialysis