Chronic kidney injury lo's

Question 1

Define chronic kidney disease

Answer 1

• eGFR <60ml/min/1.73m2 and/or persistence greater than 3 months of findings indicating irreversible kidney damage such as electrolyte imbalances, albuminuria, hematuria, retention of nitrogenous wastes, acid/base imbalances, reduced production 1,25 OH2 or renin, imagining showing structural abnormalities ( polycystic kidney disease)

Question 2

Causes CKD

Answer 2

• diabetes (diabetic nephropathy)
• hypertension (hypertensive nephropathy)
• glomerulonephritis
• AKI
• Overuse of NSAID’s
• polycystic kidney disease

Question 3

Polycystic kidney disease

Answer 3

An inherited disorder in which multiple cysts develop in the kidneys.

Question 4

CKD and anemia

Answer 4

erythropoietin produced by kidney stimulates red bone marrow to produce red blood cells –> kidney damaged–> less EPO–> less red blood cells–> anemia of chronic disease

Question 5

Anemia caused by CKD treatment

Answer 5

• erythropoiesis-stimulating agents
• red blood cell transfusion
• Iron supplement

Question 6

Hyperparathyroidism

Answer 6

abnormally high parathyroid hormone levels in the blood due to overactivity of parathyroid gland

Question 7

primary hyperparathyroidism and treatment

Answer 7

• Elevated PTH levels–> Hypercalcemia results from abnormally active parathyroid glands (too much PTH causes too much calcium released from bone)
• parathyroid gland adenoma (benign tumor of parathyroid glands)
• parathyroidectomy

Question 8

secondary hyperparathyroidism and treatment

Answer 8

• Elevated PTH levels–> hypocalcemia results in reactive overproduction of PTH (another disease/condition causes low calcium levels–> increased PTH over time)
• CKD
• Treat underlying condition
• Treat hyperphosphatemia
• Phosphate binders

Question 9

Tertiary hyperparathyroidism and treatment

Answer 9

-hypercalcemia results from untreated secondary hyperparathyroidism with continuously elevated PTH levels

Question 10

GFR and why is it calculated

Answer 10

• Rate of filtration of plasma by glomeruli
• estimated GFR (ml/min/1.73m2)= 186x (creat/88.4)-1.154 x (AGE)-0.203 x(0.742 if female) x (1.210 if black)

Question 11

GFR and CKD

Answer 11

• stages of kidney disease (1-5)
• stage 1: 90 or higher: kidney damage with normal kidney function
• stage 2: 89 to 60: kidney damage with mild loss of kidney function
• stage 3a: 59 to 45: mild to moderate loss of kidney function
• stage 3b: 44 to 30: moderate to severe loss of kidney function
• stage 4: 29 to 15: severe loss of kidney function
• stage 5: less than 15: kidney failure

Question 12

Creatinine

Answer 12

metabolite from breakdown of muscles

Question 13

Urea

Answer 13

waste product from protein breakdown

Question 14

Define uremia

Answer 14

• uremia: accumulation of toxic substances due to decreased renal excretion; mostly metabolites of proteins such as PTH, urea, creatinine, B2 microglobulin

Question 15

Complications of uremia

Answer 15

• uremic pericarditis
• pruritus
• skin colour changes
• uremic frost
• encephalopathy (coma, seizures, somnolence)
• asterixis
• anemia
• leukocyte dysfunction
• increased bleeding caused by platelet aggregation and adhesion
• nausea/vomiting/ loss of appetite
• fatigue/headaches/weakness

Question 16

Phosphate and CKD

Answer 16

When you have chronic kidney disease (CKD), your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak.