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Nephrology Fellowship Reviewer > Chronic Kidney Disease Part 2 > Flashcards

Chronic Kidney Disease Part 2 Flashcards

1
Q

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

A

CKD-MBD

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2
Q

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

A

renal osteodystrophy

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3
Q

most important regulator of intestinal absorption of Phos

A

high dietary Phos

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4
Q

major site of intestinal calcium absorption

A

duodenum

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5
Q

vitamin D independent nonsaturable pathway

A

paracellular pahtway

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6
Q

vitamin D dependent, saturable pathway

A

transcellular pathway

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7
Q

inactivation of CaSR: Calcium and PTH

A

decrease in Calcium, increase PTH secretion

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8
Q

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

A

extracellular concentration of ionized calcium

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9
Q

major source of the circulating levels of calcitriol

A

kidney

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10
Q

circulating factors that regulate phos excretion

A

phosphatonins - FGF23 and MEPE

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11
Q

surrogate of bone turnover in patients with CKD

A

PTH

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12
Q

bone turnover, microarchitecture, microfractures and mineralization

A

bone quality

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13
Q

alignment of strands of collagen has an irregular woven pattern

A

osteitis fibrosa cystica

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14
Q

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

A

low turnover (adynamic bone disease)

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15
Q

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

A

osteomalacia

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16
Q

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

A

mixed uremic osteodystrophy

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17
Q

assess the presence or absence of vascular calcification

A

plain radiographs

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18
Q

Vit D deficiency

A

less than 10 ng/mL

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19
Q

vit D insufficiency

A

10-30 ng/mL

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20
Q

decreased stratum corneum hydration and abnormal eccrine gland function

A

xerosis

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21
Q

mainstay of treatment of xerosis

A

hydration of skin

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22
Q

skin develops patterned scale with hyperkeratosis and occasionally epidermal hypogranulosis

A

acquired ichthyosis

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23
Q

most common alteration in pigment of hd patients

A

yellowish tint

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24
Q

cause of hyperpigmentation

A

increased melanin production, inc B melanocyte stimulating hormone

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25
Q

perforating folliculitis, Kyrle’s disease, reactive perforating collagenosis

A

acquired perforating dermatosis

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26
Q

crateriform, umbilicated or centrally hyperkeratotic papules and nodules resolve with scarring after 6-8 weeks

A

acquired perforating dermatosis

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27
Q

mainstay of treatment of calciphylaxis

A

supportive and preventive measures

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28
Q

calcium deposits in the tissue

A

metastatic calcification

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29
Q

trauma may result to

A

dystrophic calcification

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30
Q

deficiency of uroporphyringogen decarboxylase

A

porphria cutanea tarda

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31
Q

noninflamed blisters, erosions and crusts in dorsal of hands and forearms, blisters may heal with scarring

A

porphyria cutanea tarda

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32
Q

subepidermal cleft with minimal inflammation; festooning of the papillary dermis at the base of the celft; thickened vessel walls

A

porphyria cutanea tarda

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33
Q

IF findings in porphyria cutanea tarda

A

granular to linear staining of immunoglobulin G and C3 at the dermoepidermal junction

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34
Q

noninflamed blisters on the extremities: hands and forearms and other sun exposed areas

A

pseudophrphyria

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35
Q

drugs associated with pseudoporphyria

A

tetracycline, furosemide, naproxen, amoidarone and nalidixic acid

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36
Q

yellowish orange smooth papules and plaques that rapidly appear on buttocks and proximal extremities

A

eruptive xanthomas

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37
Q

histopathologic findings in eruptive xanthomas

A

extracellular lipid and foamy macrophages

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38
Q

vascular proliferation near or over an AV shunt

A

pseudo-kaposi’s sarcoma

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39
Q

ESRD patients who receive intravenous contrast with translucent papulonodular or vegetative lesions

A

iododerma

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40
Q

marked epidermal hyperplasia with intraepidermal pustules of neutrophils and eosinophils

A

iododerma

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41
Q

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

A

nephrogenic systemic fibrosis

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42
Q

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

A

nephrogenic systemic fibrosis

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43
Q

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

A

dialysis associated steal syndrome

44
Q

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

A

dialysis associated steal syndrome

45
Q

effective treatment of dialysis associated steal syndrome

A

fistula ligation and/or binding

46
Q

B2 microglobulin deposition, carpal tunnel syndrome and destructive arthropathy

A

dialysis related amyloidosis

47
Q

melanin deposition in the nail bed and plate, proximal white to normal half and a red brown distal half

A

lindsay’s half and half nail

48
Q

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

A

leukocytoclastic vasculitis

49
Q

numerous flesh-colored to slightly tan, smooth papules on the face that histopathologically are fibrofolliculomas or trichodiscomas

A

Birt Hogg Dube syndrome

50
Q

Birt Hogg Dubb syndrome is associated with what renal findings

A

renal cell carcinoma

51
Q

adenoma sebaceum associated with angiomyolipoma

A

tuberous sclerosis

52
Q

port wine stain, cysts, clear cell renal cell Ca

A

VHL syndrome

53
Q

sebaceous neoplasia, genitourinary carcinoma

A

muir-torre syndrome

54
Q

diagnosis of DKD

A

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

55
Q

most important risk factor in DM

A

duration

56
Q

screening of DKD in type 2 DM is recommended at

A

time of diagnosis

57
Q

screening of DKD in type 1 DM is recommended after

A

5 years of type 1 DM

58
Q

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

A

hyperglycemia

59
Q

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

A

cardiac autonomic neuropathy

60
Q

best currently available risk marker for DKD

A

albuminuria

61
Q

hallmark of DKD

A

accumulation of extracellular matrix

62
Q

early finding in DKD

A

tubular basement/GB membrane thickening

63
Q

first lesion detected by light microscopy

A

mesangial expansion

64
Q

first lesion identified by electron microscopy

A

GBM thickening

65
Q

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

A

nodular glomerulosclerosis, kimmelstiel wilson nodules

66
Q

where can nodular glomerulosclerosis be seen

A

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

67
Q

fraying of the mesangial matrix, precursor of nodular lesions

A

mesangiolysis

68
Q

subendothelial accumulations of hyaline in the glomerular capillary

A

fibrin caps

69
Q

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

A

capsular drops

70
Q

Kidney biopsy in DM patients

A

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

71
Q

Class 3 DKD Glomerular lesions

A

nodular lesions (KWL_ at least one

72
Q

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

A

ACEi

73
Q

Type 2 DM. htn, microalb RAAS blocker

A

ARB

74
Q

Overt DKD

A

ARB

75
Q

target Hba1c for prevention of DKD

A

7%

76
Q

treatment goal of dyslipidemia

A

LDL < 70-100

77
Q

protein intake for DKD

A

0.8 g/kg/day

78
Q

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

A

Burnt-out DM

79
Q

screening for anemia should begin at CKD stage

A

stage 3

80
Q

EPO is produced in what cells within renal cortex

A

peritubular interstitial cells, fibroblasts

81
Q

low hepcidin

A

iron mobilization

82
Q

high hepcidin

A

iron overload

83
Q

gold standard to monitor patients with iron overload disorders

A

liver magnetic resonance imaging

84
Q

decrease ferritin

A

vitamin C deficiency, hypothyroidism

85
Q

threshold tsat value below which iron therapy is indicated

A

20%

86
Q

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

A

transferrin and TIBC

87
Q

most sensitive indicator of functional iron deficiency

A

Retic Hegmoglobin content

88
Q

reversal agent for LMW and UFH

A

protamine sulfate

89
Q

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

A

heparin induced thrombocytopenia

90
Q

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

A

Type 1 HIT

91
Q

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

A

Type 2 HIT

92
Q

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

A

delirium disorders

93
Q

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

A

uremic encephalopathy

94
Q

headache, visual disturbance, nausea, agitation,

A

dialysis dysequlibrium

95
Q

syndrome of progressive dementia related to aluminum intoxication

A

dialysis dementia

96
Q

management of chronic cognitive impairment mild to moderate dementia

A

cholinesterase inhibitors

97
Q

treatment of moderate to severe Alzheimer’s dementia

A

Memantine

98
Q

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

A

uremic polyneuropathy

99
Q

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

A

mononeuropathy

100
Q

repetitive cessation of respiration during sleep

A

sleep apnea

101
Q

apnea associated with continued respiratory effort

A

obstructive

102
Q

apnea associated with absence of respiratory effort

A

central

103
Q

treatment of sleep apnea

A

CPAP

104
Q

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

A

restless leg syndrome

105
Q

first line therapy for more severe symptoms

A

levodopa

106
Q

second line for restless leg syndrome

A

gabapentin

107
Q

sudden and repetitive movements of the lower extremities during sleep

A

periodic limb movements of sleep

Nephrology Fellowship Reviewer (29 decks)

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