Chronic Renal Disease

Question 1

What is the definition of chronic kidney disease?

Answer 1

A permanent reduction in GFR

Question 2

What is the classification system of chronic kidney disease?

Answer 2

1: GFR ~90, evidence of kidney damage
2: GFR 60 - 89, evidence of kidney damage
3: GFR 30 - 59
4: GFR 15 - 29
5: GFR less 15

Question 3

How many people have CKD in the U.S.?

Answer 3

19.5 million

Question 4

The hallmark of CKD is ___________.

Answer 4

loss of flexibility in responding to changes in external balance of sodium and water

Question 5

If a person with CKD eats too much sodium, they get ________; if they eat too little, then they get __________.

Answer 5

edema; volume depleted

Question 6

Patients with CKD can become hyperkalemic with ___________.

Answer 6

large intakes of potassium

Question 7

The ___________ is where ammonia is made.

Answer 7

proximal tubule

Question 8

What are the most common causes of CKD?

Answer 8

Diabetic nephropathy
Hypertensive glomerulosclerosis
Glomerulonephritis
Polycystic kidney disease
Interstitial nephritis
Obstruction

Question 9

Why is CKD silent?

Answer 9

• Functioning nephrons can compensate for others that are impaired
• Nephrons can magnify their handling of solutes to compensate
• Solutes have control systems that coordinate in response to loss of function

Question 10

How much acid is generated per day?

Answer 10

1 mEq/kg per day

Question 11

Metabolic acidosis appears when kidney function falls below _________.

Answer 11

25%

Question 12

What regulates gut absorption of calcium?

Answer 12

Vitamin D

Question 13

Almost every CKD patient has ________ when GFR falls below 25 ml/min.

Answer 13

anemia (due to lack of erythropoiesis)

Question 14

One of the most common symptoms of CKD is ___________.

Answer 14

hypertension

Question 15

All patients with CKD are in the highest risk stratification for ___________.

Answer 15

cardiovascular disease

Question 16

What are the four main principles of CKD management?

Answer 16

Delay CKD progression (through BP control)
Treat complications of CKD
Screen for cardiovascular disease
Prepare for dialysis

Question 17

Nephrologists aim to keep the BP of CKD patients below _______.

Answer 17

130/80

Question 18

All diabetics with CKD should be given ________.

Answer 18

ACEi or ARBs

Question 19

Creatinine clearance is proportional to __________.

Answer 19

serum concentration

Question 20

GI excretion can handle ________ percent of the potassium load in extreme states of CKD.

Answer 20

50

Question 21

What is the new understanding of calcium balance in CKD?

Answer 21

High phosphate levels lead to secretion of FGF-23 and PTH
FGF-23 suppresses vitamin D function
Declining vitamin D leads to decreased calcium absorption

Question 22

Anemia develops when GFR drops below _______.

Answer 22

25 ml/min

Question 23

Can any therapy stop the progression of CKD?

Answer 23

No