Chronic Kidney Disease Part 2 Flashcards by fernanda moraes

one or both: abnormalities of ca, phos, PTH, vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth or strength, vascular or other soft tissue calcification

CKD-MBD

How well did you know this?

Not at all

Perfectly

alteration of bone morphology in patients with CKD, one measure of skeletal component

renal osteodystrophy

How well did you know this?

Not at all

Perfectly

most important regulator of intestinal absorption of Phos

high dietary Phos

How well did you know this?

Not at all

Perfectly

major site of intestinal calcium absorption

duodenum

How well did you know this?

Not at all

Perfectly

vitamin D independent nonsaturable pathway

paracellular pahtway

How well did you know this?

Not at all

Perfectly

vitamin D dependent, saturable pathway

transcellular pathway

How well did you know this?

Not at all

Perfectly

inactivation of CaSR: Calcium and PTH

decrease in Calcium, increase PTH secretion

How well did you know this?

Not at all

Perfectly

most important determinant of minute to minute secretion of PTH From stored secretory granules

extracellular concentration of ionized calcium

How well did you know this?

Not at all

Perfectly

major source of the circulating levels of calcitriol

kidney

How well did you know this?

Not at all

Perfectly

circulating factors that regulate phos excretion

phosphatonins - FGF23 and MEPE

How well did you know this?

Not at all

Perfectly

surrogate of bone turnover in patients with CKD

PTH

How well did you know this?

Not at all

Perfectly

bone turnover, microarchitecture, microfractures and mineralization

bone quality

How well did you know this?

Not at all

Perfectly

alignment of strands of collagen has an irregular woven pattern

osteitis fibrosa cystica

How well did you know this?

Not at all

Perfectly

histologically by absence of cellular activity, osteoid formation and endosteal fibrosis

low turnover (adynamic bone disease)

How well did you know this?

Not at all

Perfectly

excess of unmineralized osteoid, wide osteoid seams, decreased mineralization rates

osteomalacia

How well did you know this?

Not at all

Perfectly

bone biopsies with secondary hyperparathyroidism with mineralization defect: extensive osteoclastic and osteoblastic activity and increased endosteal peritrabecular fibrosis

mixed uremic osteodystrophy

How well did you know this?

Not at all

Perfectly

assess the presence or absence of vascular calcification

plain radiographs

How well did you know this?

Not at all

Perfectly

Vit D deficiency

less than 10 ng/mL

How well did you know this?

Not at all

Perfectly

vit D insufficiency

10-30 ng/mL

How well did you know this?

Not at all

Perfectly

decreased stratum corneum hydration and abnormal eccrine gland function

xerosis

How well did you know this?

Not at all

Perfectly

mainstay of treatment of xerosis

hydration of skin

How well did you know this?

Not at all

Perfectly

cause of hyperpigmentation

increased melanin production, inc B melanocyte stimulating hormone

How well did you know this?

Not at all

Perfectly

mainstay of treatment of calciphylaxis

supportive and preventive measures

How well did you know this?

Not at all

Perfectly

calcium deposits in the tissue

metastatic calcification

How well did you know this?

Not at all

Perfectly

trauma may result to

dystrophic calcification

vascular proliferation near or over an AV shunt

pseudo-kaposi's sarcoma

bound down indurated skin, cobblestone apperance, edema and erythema early on; exposure to gadolinium

nephrogenic systemic fibrosis

Histopath: increased dermal and/or subcutaneous fibroblast-like cells cells stain with procollagen I and CD34

nephrogenic systemic fibrosis

rare complication of fistula construction leading to decreased distal perfusion involving brachial area

dialysis associated steal syndrome

pallor or a reticulated pink to blue discoloration of the skin with necrosis, ulceration or gangrene

dialysis associated steal syndrome

effective treatment of dialysis associated steal syndrome

fistula ligation and/or binding

B2 microglobulin deposition, carpal tunnel syndrome and destructive arthropathy

dialysis related amyloidosis

leukocytoclasia, fibrin thrombi, nonblanching papules and plaques in lower extremities

leukocytoclastic vasculitis

Birt Hogg Dubb syndrome is associated with what renal findings

renal cell carcinoma

adenoma sebaceum associated with angiomyolipoma

tuberous sclerosis

port wine stain, cysts, clear cell renal cell Ca

VHL syndrome

diagnosis of DKD

urine ACR 30 mg/g or higher, eGFR \< 60 ml/min

most important risk factor in DM

duration

screening of DKD in type 2 DM is recommended at

time of diagnosis

screening of DKD in type 1 DM is recommended after

5 years of type 1 DM

important predictor of progression of advanced kidney disease, clinical hallmark of diabetes

hyperglycemia

abnormalities in heart rate and vascular dynamics: resting tachycardia and orthostatic hypotension

cardiac autonomic neuropathy

best currently available risk marker for DKD

albuminuria

hallmark of DKD

accumulation of extracellular matrix

early finding in DKD

tubular basement/GB membrane thickening

first lesion detected by light microscopy

mesangial expansion

first lesion identified by electron microscopy

GBM thickening

prominent round expansion of hypocellular mesangial matrix with palisading mesangial cells in the periphery of the nodule surrounded by glomerular capillaries

nodular glomerulosclerosis, kimmelstiel wilson nodules

where can nodular glomerulosclerosis be seen

DKD, light chain deposition disease, immune complex processes, idiopathic nodular glomerulosclerosis

fraying of the mesangial matrix, precursor of nodular lesions

mesangiolysis

subendothelial accumulations of hyaline in the glomerular capillary

fibrin caps

accumulation of hyaline under the parietal epithelial cell lining of Bowman's capsule

capsular drops

Kidney biopsy in DM patients

sudden onset proteinuria, onset of proteinuria less than 5 years from type 1 DM, proteinuria in absence of retinopathy, AKI, active urinary sediment, hematuria

Class 3 DKD Glomerular lesions

nodular lesions (KWL\_ at least one

RAAS blocker of choice: Type 1 DM, Htn, Albuminuria

ACEi

Type 2 DM. htn, microalb RAAS blocker

ARB

Overt DKD

ARB

target Hba1c for prevention of DKD

treatment goal of dyslipidemia

LDL \< 70-100

protein intake for DKD

0.8 g/kg/day

DM patients on dialysis with spontaneous resolultion of hyperglycemia with Hba1c less than 6%

Burnt-out DM

screening for anemia should begin at CKD stage

stage 3

EPO is produced in what cells within renal cortex

peritubular interstitial cells, fibroblasts

low hepcidin

iron mobilization

high hepcidin

iron overload

gold standard to monitor patients with iron overload disorders

liver magnetic resonance imaging

decrease ferritin

vitamin C deficiency, hypothyroidism

threshold tsat value below which iron therapy is indicated

20%

dual markers of iron status as well as of nutritional and protein balance

transferrin and TIBC

most sensitive indicator of functional iron deficiency

Retic Hegmoglobin content

reversal agent for LMW and UFH

protamine sulfate

thrombocytopenia 5-10 days after the start of heparin therapy, persistence of any acute thrombotic event, normal platelet count before heparin, trhombocytopenia with no other causes; resolution after heparin cesation; HIT antibody seroconversion

heparin induced thrombocytopenia

first 2 days after exposire to heparin and platelet count normalizes with continued heparin therapy

Type 1 HIT

immune mediated disorder that typically occurs 4-10 days after exposure to heparin and has life and limb threatening thrombotic complications

Type 2 HIT

acute confusional state characterized by recent onset of fluctuating awareness, disorganized thinking, impairment of memory and attention

delirium disorders

syndrome of delirium seen in inadequately treated ESKD - lethargy, confusion and seizures or coma

uremic encephalopathy

headache, visual disturbance, nausea, agitation,

dialysis dysequlibrium

syndrome of progressive dementia related to aluminum intoxication

dialysis dementia

management of chronic cognitive impairment mild to moderate dementia

cholinesterase inhibitors

treatment of moderate to severe Alzheimer's dementia

Memantine

distal symmetric, mixed sensorimotor polyneuropathy, symmetric muscle weakness, areflexia and loss of vibratory sense

uremic polyneuropathy

compression or ischemia of the ulnar or median nerves and often dialysis related, amyloidosis or AVF

mononeuropathy

repetitive cessation of respiration during sleep

sleep apnea

apnea associated with continued respiratory effort

obstructive

apnea associated with absence of respiratory effort

central

treatment of sleep apnea

CPAP

urge to move the legs associated with feelings of discomfort or paresthesias

restless leg syndrome

first line therapy for more severe symptoms

levodopa

second line for restless leg syndrome

gabapentin

sudden and repetitive movements of the lower extremities during sleep

periodic limb movements of sleep