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Block 34 metabolic -Ellen > Chronic kidney injury Pt 1 > Flashcards

Chronic kidney injury Pt 1 Flashcards

1
Q

CKD definition

A

progressive loss of renal function over time

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2
Q

what is CKD clinically based on

A

GFR and creatinine

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3
Q

diagnosis of CKD requires

A

decline in kidney function over 3 months and

evidence of kidney damage or GFR <60

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4
Q

End stage kidney disease=

A

when kidney function is insufficient to maintain life without RRT

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5
Q

main causes of CKD (5)

A
  • diabetes
  • hypertension
  • PKD
  • GN
  • recurrent UTIs
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6
Q

signs/symptoms of CKD

A 
hypertension 
azotaemia
hyperkalaemia 
metabolic acidosis 
anaemia 
hypocalcaemia
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7
Q

what type of anaemia in CKD

A

normochromic normocytic due to lack of EPO

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8
Q

metabolic acidosis causes

A

SOB

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9
Q

hypocalcemia due to

A

vitamin D deficiency

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10
Q

stage G1 =

A

> 90

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11
Q

stage 2=

A

60-89

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12
Q

stage 3a

A

45-59

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13
Q

stage 3b

A

30-44

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14
Q

stage 4

A

15-29

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15
Q

stage 5

A

<15

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16
Q

management of CKD stage 1/2 without uremia

A

ACEi or ARB
statin
diuretics
Calcium channel blocker

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17
Q

name 2 non-dihydropyridine calcium channel blockers

A

Diltiazem

Verapamil

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18
Q

danger of ACEi and spironolactone

A

hyperkalaemia

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19
Q

additions for management of stage 3/4

A
  • Ezetimibe
  • additional antihypertensives- thiazides, spironolactone, beta blockers
  • EPO stimulating agent
  • iron supplements
  • calcitriol
  • oral bicarbonate
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20
Q

calcitrol=

A

active 1,25 vitamin D therapy

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21
Q

treatment of stage 5 ESRD

A

dialysis or kidney transplant

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22
Q

when is oral bicarbonate indicated

A

when bicarbonate levels lower than 15mmol/L

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23
Q

Azotaemia in CKD due to

A

impaired function of the kidney urea is not effectively filtered and removed

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24
Q

3 consequences of raised urea

A

pruitus
encephalopathy
N&V

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25
Q

only way to treat uremia

A

dialysis

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26
Q

why anaemia in CKD

A

lack of EPO

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27
Q

treatment of anaemia in CKD

A

IV EPO stimulating agent

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28
Q

Bp target for people with CKD

A

<130/80

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29
Q

why oedema in CKD

A

due to proteinuria and blood hypoalbuminemia decreasing blood osmolarity

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30
Q

treatment of oedema

A

IV furosemide

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31
Q

what can high doses of IV furosemide cause

A

ototoxicity

32
Q

why hyperlipidemia in CKD

A

bi-product of synthesis of albumin is low-density lipoprotein

33
Q

treatment of hyperlipidemia =

A

statins with or without ezetimibe

34
Q

bone metabolism in the kidney

A

hydroxylation of inactive 25(OH) vit D to active 1,25(OH)2 vit D

35
Q

in CKD what happens to bone metabolism

A

Vit D deficiency means less absorption of calcium from gut therefore increased PTH stimulating osteoclast to release calcium from bone

36
Q

whats it called when kidney function is effected by an obstruction in urinary flow

A

obstructive nephropathy

37
Q

hydronephrosis=

A

dilation of the renal pelvis

38
Q

common causes of obstructive uropathy (4)

A
  • renal calculi
  • BPH
  • prostate cancer
  • bladder tumours
39
Q

what is often related to unilateral obstrutive uropathy

A

renal calculi

40
Q

what is often related to obstructive nephropathy

A

BPH

41
Q

pathophysiology of obstructive nephropathy

A

back-flow of urine causes increased pressure and a hydronephrosis resulting in reduced renal blood flow, decreased GFR, ischaemia and increased RAAS

42
Q

end result of obstructive nephropathy in the kidney

A

atrophy and apoptosis of renal tubules, interstitial tissue fibrosis via macrophage infiltration

43
Q

high pressure within the tubules in obstructive nephropathy causes

A

reabsorption of Na, water and urea

44
Q

lab results of obstructive nephropathy

A

hypernatremia
low urinary Na
high BUN: cr ratio
high urine osmolarity

45
Q

risk factors for obstructive uropathy (7)

A 
BPH
constipation 
medications 
urolithiasis 
parkinson's 
MS 
malignancy- prostatic, bladder, cervical and colon
46
Q

physical side effects of haemodialysis (5)

A
  • fatigue
  • insomnia
  • bone and joint pain
  • loss of libido
  • dry mouth and anxiety
47
Q

physical complications of peritoneal dialysis (6)

A
  • peritonitis
  • abdominal pain
  • weight gain
  • fever and rigors
  • N&V
  • increased risk of umbilical hernia
48
Q

why is delirium seen in dialysis patients

A

electrolyte imbalances

49
Q

average waiting list for kidney transplant

A

> 3 years

50
Q

2 types of dialysis

A

haemodialysis

peritoneal

51
Q

more efficient dialysis=

A

haemodialysis

52
Q

times /week of haemodialysis

A

3 days

53
Q

times/ week of peritoneal dialysis

A

everyday

54
Q

what are antibodies

A

glycoproteins part of the immunoglobulin superfamily

55
Q

what is the antigen-binding fragment (Fab) composed of

A

one constant and one paratope variable domain

56
Q

what determines the Fab region

A

idiotype

57
Q

what is a paratope

A

the variable antigen-binding site on the Fab domain

58
Q

what is the fragment crystallisable region (Fc domain)

A

the constant tail region of the antibody

59
Q

what does the Fc domain interact with

A

immune effect cells to coordinate the appropriate response to antigen

60
Q

what determines the heavy domain

A

isotype

61
Q

what does the isotype/ Fc domain determine

A

the function of an antibody

62
Q

what antibodies do Naive B cells express

A

IgM and IgD

63
Q

how are other antibodies formed

A

by class switching after antigen exposure in the germinal centre of the lymph nodes

64
Q

first antibody expressed during B cell development=

A

IgM

65
Q

structure of IgM and function

A
  • pentameric connected by central J chain

- major antibody in primary immune response -complement cascade as well

66
Q

most abundant immunoglobulin in serum =

A

IgG

67
Q

what does IgG do

A

helps bacterial immobilisation and neutralise toxin and viruses

68
Q

only antibody that can cross the placenta=

A

IgG

69
Q

IgA is secreted in the

A

respiratory and intestinal tract- mucosal immunity

70
Q

shape of IgA

A

2 monomeric proteins connected by J chain

71
Q

antibody present in the lowest concentration in the blood plasma=

A

IgE

72
Q

main antibody for allergic reactions=

A

IgE -induce mast cells, eosinophils and langerhan cells

73
Q

main categories of antibody action=

A

neutralisation
agglutination
precipitation
complement activation

74
Q

aggulatination=

A

many antibodies bind to foreign cells forming aggregating clumps inducing phagocytosis by macrophages

75
Q

precipitation=

A

many antibodies bind to serum-soluble antigens forming a precipitant which recruits macrophages and phagocytosis

76
Q

what can an activated B cell differentiate into (2)

A

plasma cell

memory cell

Block 34 metabolic -Ellen (8 decks)

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