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Nephrology > Chronic Kidney Disease Part 1 > Flashcards

Chronic Kidney Disease Part 1 Flashcards

1
Q

Hallmark of DM nephropathy

A

persistent albuminuria > 300 mg/24 hours

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2
Q

DM nephropathy diagnosed clinically if the following are fulfilled

A

dm retinopathy + absence of clinical or laboratory evidence of other kidney or renal tract disease

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3
Q

urinary albumin excretion of > 30 mg/24 hours and less than 300 mg/24 hours in 2 of 3 samples

A

microalbuminuria

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4
Q

first pathologic sign in dm nephropathy type 1 dm and proteinuria

A

glomerular basement membrane thickening

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5
Q

arteriolar hyalinosis usually seen within

A

3 to 5 years

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6
Q

exudative lesions in type 1 DM nephropathy pathology

A

arteriolar hyalinosis, bowmans capsular drops, hyaline caps

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7
Q

45-59 ml/min GFR

A

stage 3a

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8
Q

GFR 30-44

A

stage 3b

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9
Q

GFR 15-29

A

stage 4

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10
Q

GFR less than 15

A

stage 5

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11
Q

BP target in CKD with proteinuria

A

less than 130/80

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12
Q

BP target if no proteinuria

A

less than 140/80

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13
Q

education on RRT and hepatitis B vaccination

A

Stage 4

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14
Q

AVF creation

A

stage 5

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15
Q

Goal for Acei or ARB treatment

A

urine protein level < 0.5 g/day

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16
Q

target for weight loss in obese patients

A

5%

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17
Q

dietary salt restriction

A

<5 g (90 meqs sodium per day)

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18
Q

protein requirement for normal adults or those with uncomplicated CKD

A

0.8 g protein/kg/day

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19
Q

CKD patients with complications

A

0.6 g protein/kg/day or 0.3 g/kg + ketoacids or a mixture of aminoacid

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20
Q

CKD patients with loss of muscle mass

A

0.8 g protein/kg/day

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21
Q

CKD with proteinuria

A

< 0.8 g protein/kg/day + 1 g protein/g proteinuria

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22
Q

at least 3 episodes of itch in a 2 week period that causes difficulty for the patient or as itch that occurs over a 6 month period in a regular pattern

A

pruritus

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23
Q

associated with hyperparathyroidism or elevated Ca x Phos

A

calciphylaxis

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24
Q

main regulator of systemic iron hoemostasis

A

hepcidin

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25
Q

increase in PTH secretion immediate effects

A

increase in 1a hydroxylase activity, bone turnover, ca reabsoprtion
decrease in renal po4 reabsorption

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26
Q

more than 3 rbc/hpf in atleast 2 of 3 freshly voioded midstream clean catch urine

A

asymptomatic hematuria

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27
Q

most common cause of hematuria in young women

A

UTI

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28
Q

most common cause of hematuria in older patients

A

malignancy

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29
Q

gross hematuria more pronounced on initiation

A

urethral source

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30
Q

gross hematuria more pronounced on termination

A

bladder neck/prostatic urethra

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31
Q

preferred initial imaging modality

A

computed tomography

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32
Q

next best initial imaging test

A

renal ultrasonography

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33
Q

imaging to localize and control source of bleeding

A

cystoscopy

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34
Q

diagnostic when there is any suspicion of upper tract disease

A

retrograde pyelography

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35
Q

glomerular hematuria + active urine sediment + wbcs/casts

A

nephritic syndrome

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36
Q

hallmark of nephritic syndrome

A

glomerular hematuria

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37
Q

definitive finding in nephritic syndrome

A

rbc casts

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38
Q

principal underlying abnormality in nephrotic syndrome

A

increased permeability of the glomerular capillaries

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39
Q

most common underlying systemic disease causing nephrotic syndrome

A

Diabetes Mellitus

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40
Q

1+ urine dipstick protein is equivalent

A

30-100 mg/dL

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41
Q

most common urine lipid

A

esterified cholesterol

42
Q

birefingent birght cross like appearance in polarizing microscope

A

lipiduria

43
Q

type of RTA associated in obstructive uropathy

A

type 4

44
Q

test of choice to diagnose obstructive uropathy

A

renal ultrasonography

45
Q

stage 1 hypertension

A

140-159/90-99

46
Q

benzene ring-shaped cysteine crustals

A

cystinuria

47
Q

coffin lid crystals

A

struvite

48
Q

imaging procedure of choice for stones

A

noncontrast helical CT scan

49
Q

radioopaque stones

A

calcium, cysteine

50
Q

radiolucent stones

A

uric acid, indinavir or triamterene stones

51
Q

size of stones that will pass spontaneously

A

4 mm

52
Q

most important vascular complication in patients with CKD

A

CAD

53
Q

strongest indicator of possible renal underpefusion

A

overt hypotension

54
Q

normal blood glucose in OGTT

A

less than 140 mg/dL

55
Q

impaired glucose tolerance or preDM

A

OGTT 140-199 mg/dL

56
Q

primary cause of insulin resistance in uremia

A

impaired tissue sensitivity

57
Q

independent risk factors for cardiovascular complication in patients with ESKD

A

insulin resistance and hyperinsulinemia

58
Q

uremic dyslipidemia

A

increased triglycerides, ldl and vldl, decreased hdl cholesterol

59
Q

metformin should be used with caution when eGFR is

A

less than 60 ml/min

60
Q

when to discontinue metformin

A

less than 30 ml/min

61
Q

insulin sensitizer, causes lactic acidosis in CKD

A

metformin

62
Q

T3 levels in CKD

A

low due to low conversion of T4

63
Q

strong inhibitors of protein binding of T4

A

urea, creatinine, indoles, phenols ,heparin

64
Q

Increase in GH secretion

A

fasting, insulin induced hypoglycemia, increase of protein

65
Q

glucose load in growth hormone secretion

A

decrease GH secretion

66
Q

reason for reduced linear bone growth in CKD

A

reduced effectiveness of GF and IGF-1

67
Q

primary mediator of effects of GH

A

IGF-1

68
Q

GH deficiency in GFR and renal plasma flow

A

decrease GFR and plasma flow

69
Q

reason for GH resistance

A

decreased GH receptors and post GH receptor defects, decreased IGF-1 synthesis

70
Q

stimulates protein synthesis, decreases urea generation and improves nitrogen balance

A

recombinant human GH

71
Q

adverse reaction to GH treatment

A

benign intracranial hypertension, hyperglycemia, fluid retention

72
Q

most abundant steroid hormone

A

DHEA

73
Q

antifibrotic and antiapoptotic effects in kidney

A

estrogen

74
Q

responsible for decreased libido, erectile dysfunction, oliospermia and infertility, osteopenia in adults with ESKD

A

hypogonadism, low testoteron and hyperprolactinemia

75
Q

development of lipid enriched plaques in the intimal layer of the artery

A

atherosclerosis

76
Q

phenomenon of noncalcified nonatheromatous stiffening of smaller muscular arteries

A

arteriolosclerosis

77
Q

characterized by medial thickening and heavy calcification without the presence of atheroma

A

monckerberg’s medial calcific sclerosis

78
Q

LV remodeling occurs as early as

A

stage 2

79
Q

indirect risk factors of CVD/CKD

A

DM, obesity

80
Q

partially treated uremia and side effects of dialysis

A

residual syndrome

81
Q

most abundant solute excreted by kidney

A

urea

82
Q

uremic toxin that impairs platelet function

A

guanidosuccinic acid

83
Q

aromatic waste compound normally excreted in the largest quantity

A

hippurate

84
Q

uremic solute associated with cardiovascular death in patients undergoing hd

A

p-cresol sulfate

85
Q

Fractional excretion of calcium remains unchanged until gfr

A

<25 ml/min

86
Q

As GFR decrease Na and Phosphate is maintained by

A

Decreased reabsorption

87
Q

absence of cellular (osteoblast and osteoclast) activity, osteoid formation and endosteal fibrosis

A

low turn over (adynamic bone disease)

88
Q

bone biopsies that features secondary hpt and mineralization defect, extensive osteoclastic and osteoblastic activity and increased endosteal peritrabecular fibrosis with more osteoid

A

mixed uremic osteodystrophy

89
Q

rate of skeletal remodeling: bone resoprtion + formation

A

turn over

90
Q

how well bone collagen calcified during the formation phase of skeletal remodeling

A

mineralization

91
Q

amount of bone per unit volume of tissue

A

volume

92
Q

Dxa to assess fracture risk is recommended/not recommended in

A

stage 1-3/stage 3b-5

93
Q

LV remodeling occurs

A

Stage 2-3 CKD

94
Q

primary disease of cardiac muscle assoc with ckd causing systolic dysfunction; interstitial myocardial fibrosis

A

Uremic cardiomyopathy

95
Q

when is statins recommended in ckd

A

Stage 3-5 in older than 50 years or less than 50 yo with additional risk factors

96
Q

screening of anemia starts at stage

A

G3

97
Q

tx of aluminum toxicity

A

deionized water or chelation with desferrioxamine

98
Q

most effective tx of posttransplantation erythrocytosis

A

Raas blocker

99
Q

gold standard in assesing iron stores

A

Bone marrow iron

100
Q

if hit is established, what should be considered

A

Direct thrombin inhibitors or factor Xa

101
Q

Other tx for uremic bleeding

A

Ddvap
cryoprecipitate
estrogen

102
Q

primary prevention of stroke

A

aspirin

Nephrology (28 decks)

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