Chronic kidney disease I

Question 1

definition: CKD

Answer 1

presence of KIDNEY DAMAGE or DECREASED KIDNEY FUNCTION for 3 or more MONTHS, irrespective of cause

Question 2

kidney damage is identified by the presence of one of the following:

Answer 2

• albuminuria
• urinary sediment abnormalities (casts)
• electrolyte and other abnormalities due to tubular disorders
• imaging abnormalities
• kidney biopsy
• kidney transplantation

Question 3

decreased kidney function is quantified as eGFR below:

Answer 3

60 mL / min per 1.73 m2

Question 4

why is it important to identify people with CKD?

Answer 4

increased risk for all-cause and CV mortality, ESRD, AKI, and CKD progression

Question 5

ESRD-causing polymorphisms are located in what gene? what is the inheritance pattern?

Answer 5

• apolipoprotein L1 (APOL1)

- autosomal recessive

Question 6

APOL1 mutations are also associated with what conditions?

Answer 6

• earlier onset of kidney disease

- more rapid decline in eGFR

Question 7

what is the most significant risk factor for CKD?

Answer 7

diabetes

Question 8

what is the gold standard exogenous filtration marker of GFR?

Answer 8

inulin

Question 9

what are the eGFR values for CKD stages 1-5?

Answer 9

stage I: over 90 mL/min 
stage 2: 60-89 mL/min 
stage 3: 30-59 mL/min 
stage 4: 15-29 mL/min 
stage 5: under 15 mL/min

Question 10

what are the criteria for revised stages of CKD?

Answer 10

• cause
• six categories of GFR
• three categories of albuminuria

Question 11

what are the compensatory chances in renal hemodynamics seen in progressive renal failure?

Answer 11

• increased intraglomerular pressure (systemic or arteriole mediated)
• glomerular hyperfiltration in preserved nephrons

Question 12

how do the maladaptive changes seen in progressive renal failure cause decline in GFR?

Answer 12

• direct endothelial cell damage
• formation of subendothelial hyaline deposits narrow capillary lumens, decreasing perfusion and filtration
• increased strain on mesangial cells, stimulating release of cytokines and mesangial expansion

Question 13

proteinuria alone may contribute to disease progression by which mechanisms?

Answer 13

• mesangial toxicity
• tubular overload and hyperplasia
• toxicity from specific filtered compounds
• induction of proinflammatory molecules such as monocyte chemoattractant protein-1 (MCP) and cytokines

Question 14

definition: CKD progression

Answer 14

• decline in GFR category

- drop in GFR category accompanied by a 25% or greater drop in eGFR from baseline

Question 15

definition: rapid progression

Answer 15

sustained decline in eGFR of more than 5 mL/min/1.73 m2/yr

Question 16

what is the management for patients with CKD progression?

Answer 16

• review current management
• examine for reversible causes
• consider referral