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RENAL II Exam 3 > Chronic Renal Failure CIS > Flashcards

Chronic Renal Failure CIS Flashcards

1
Q

stage 1 CKD

A

GFR > 90

*diabetics

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2
Q

stage 2 CKD

A

GFR 60-89

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3
Q

stage 3 CKD

A

GFR 30-59

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4
Q

chronic kidney disease**

A

stage 3 for 3 months

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5
Q

70% of CKD**

A

HTN or DM

then GN and cystic disease
then prostate and tubulointerstitial disease

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6
Q

important signs of CKD

A 
bone disease
anemia
broad waxy casts
paresthesias
bilateral small kidneys
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7
Q

decreased GFR causing HTN

A

decreased sodium > turns on sympathetics > turns on RAAS

therefore - get sodium and water retention

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8
Q

bone disease and CKD

A

PTH

  • normally inhibits P reabsorption and increases Ca reabsorption
  • CKD - no 1,25 hydrox of Vit D
  • decreased PTH and no Ca reabsorption
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9
Q

phosphate vs. calcium

A

decreased GFR

  • PTH can’t get rid of P
  • P goes up, and Ca goes down
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10
Q

decreased GFR and P/Ca

A

increased P and decreased Ca

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11
Q

Vit D metabolism

A

1 hydrox - liver
25 hydrox - kidney (prox tub)

  • therefore don’t get Vit D
  • calcium low
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12
Q

low Ca

A

activates PTH release

  • increased osteoclast bone resorption
  • get osteitis fibrosia cystica
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13
Q

anemia and CKD

A

no erythropoietin

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14
Q

isosthenuria

A

same concentrated urine

-with CKD

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15
Q

waxy broad casts

A

chronic renal disease

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16
Q

subepithelial deposit humps
IgG and C3
hematuria and RBC casts
complement low

A

immune complex disorder
-post-infectious GN

shunt -staph

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17
Q

synpharyngitic hematuria

A

same time as infection

post-strep week later**

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18
Q

mesangium

A

IgA nephropathy

-most common in world

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19
Q

prognosis with proteinuria?

A

more proteinuria - gets worse

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20
Q

bergers disease

A

IgA nephropathy

-IgA1 - galactose deficiency in O-linked glycans

diseases with altered IgA - hepatic cirrhosis, HIV, CMV, celiac disease

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21
Q

IgA nephropathy with arthralgia, nausea, colic, melena, rash

A

henoch-schonlein

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22
Q

heamturia, rash, P-ANCA, RBC casts

A

microscopic polyangitis

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23
Q

P-ANCA

A 
microscopic polyangitis (churg strauss)
-no granulomatous inflammation and no upper resp involvement**
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24
Q

C-ANCA

A

granulomatosis with polyangitis

-wegeners

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25
Q

pauci immune

A

not immune complex
-but instead neutrophil activation

ANCA type**

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26
Q

formation of ANCAs

A

MPO - antibodies to strong cations - pANCA

PR3 - antibodies to neutral/weak cations - cANCA

27
Q

pANCA

A

anti-MPO - strong cations

28
Q

cANCA

A

anti-PR3 - neutral/weak cations

29
Q

anti-GMB disease

A

alpha 3 chain of type IV collagen

30
Q

linear antibody deposition

A

goodpasture

or anti-GMB GN

31
Q

hematuria, hepatosplenomegaly, cold night purpura, RBC casts, hep C positive

A

essential mixed cryoglobulinemia

32
Q

cryoglobulinemia

A

hep C

-antibodies against antibodies

33
Q

cold aggultinin

A

mycoplasm

34
Q

type 1 cryoglobulinemia

A

cancers of blood and immune system

35
Q

type 2 and 3 cryoglobulinemia

A

autoimmune diseases and viruses (Hep C)

36
Q

ultimate causes of lots of disorders

A

malignancy
autoimmune
infection
drugs

37
Q

best initial treatment for most CKD patients

A

ACE inhibitors

-unless Cr over 3**

38
Q

type I MPGN

A

subendo and subepi

  • complement low (C3 and C4)***
  • tram-tracking

typically with Hep C virus

39
Q

type II MPGN

A
  • complement normal

- dense deposit disease

40
Q

Hep C virus**

A

1 type I MPGN (nephritic
2 mixed cryoglobulinemia (nephritic)
3 membranous nephropathy (nephrotic)

41
Q

type II MPGN

A

dense deposit disease

  • alternate complement
  • C3 low, C4 normal***
  • ribbon like deposits
42
Q

low C3

A

type II MPGN

43
Q

low C3 and C4

A

type I MPGN

44
Q

Tx for nephritic

A

ACE (-)** - for proteinuria

methylpredisolone for proteinuria > 1 g/day and GFR >70

cyclophosphamide for GFR <70 and prediction to ESRD within 5 years

45
Q

black, HIV, heroin, HTN, periorbital edema, oval fat bodies

A

likely FSGS

46
Q

FSGS

A

focal and segmental

  • polymorphisms in APOL1 gene (blacks)
  • C1q nephropathy

HIV, heroin, obesity, UV reflux

47
Q

lymphoma, edema, weight gain, recurrent infections, dyspnea, thickened GBM with spike and dome of subepithelial deposits

A

membranous GN

48
Q

membranous GN

A

cause - lymphoma, carcinoma, PCN, gold, SLE, MCTD, thyroiditis, Hep B/C, endocarditis, syphilis

IgG and C3 spike and dome subepithelial deposits

49
Q

PLA2

A

hereditary membranous GN

50
Q

alpha-1 antithrombin***

A

gets through the glomerulus

  • get clotting
  • nephrotic syndrome
51
Q

nephrotic

A

loss of antithrombin III
protein C
protein S

increased lipoprotein, fibrinogen, and platelet aggregation

52
Q

causes of chronic tubulointerstitial disease**

A

proud american veterans love GM

prostate
analgesics
VUR
lead
gout
myeloma
53
Q

back pain and increased sed rate

A

multiple myeloma

54
Q

non-anion gap acidosis**

A

hyperchloremic acidosis**

55
Q

myeloma

A

can give you low anion gap

56
Q

RTA type I

A

distal tubules
-failure of H secretion by alpha intercalated cells

urine pH >5.5 (cannot secrete protons to acidify urine)

basic urine**

57
Q

RTA type II

A

proximal

-failure of HCO3 reabsorption in prox tub

58
Q

RTA type IV

A

adrenal
-aldosterone deficiency

get high potassium**

59
Q

multiple myeloma

A

damage prox tubule

-RTA type II

60
Q

causes of type I RTA**

A

ampoteracin B
hyper PTH
sjogrens

distal tubule H secretion problems

61
Q

causes of type II RTA**

A

myeloma protein, tenovofir, toluene, acetazolamide, toperimate, zonisamide

62
Q

Cl/HCO3 relationship

A

Cl high - bicarb low

> metabolic alkalosis

63
Q

fanconi syndrome

A

bence jones proteins damaged prox tub and caused to leak HCO3

64
Q

myeloma kidney

A 
high Ca
high uric
amyloidosis
B cell infiltrates
hyperviscosity

RENAL II Exam 3 (17 decks)

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