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Patho > CKD 1 > Flashcards

CKD 1 Flashcards

0
Q

What is GFR?

A
  • Glomerular filtration rate

- amount of blood filtered by the glomerulus per minute

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1
Q

Tiny cluster of capillaries that receive blood from the afferent arteriole..?

A

Glomerulus

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2
Q

What is creatinine?

A
  • by product of muscle metabolism
  • freely filtered by the kidneys
  • elevated when there is renal failure
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3
Q

Describe stage 1-3 kidney disease.

Describe the care for these stages.

A

Stage 1: normal
Stage 2: GFR = 60ml/min/1.73m2, mild kidney damage
Stage 3: GFR = 30-60ml/min/1.73m2, moderate kidney damage

  • identification, screening and management of high risk patients
  • diagnosis and treatment of high risk renal diseases
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4
Q

Describe stage 4 CKD.

Describe the care for this stage.

A

GFR = <30ml/min/1.73m2, severe kidney damage

  • management of non-nephrology issues
  • co-management of hypertension and cardiovascular risk factors
  • CKD-related anemia, Ca2+, K+, PTH abnormality treatment
  • education and preparation for possible renal replacement
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5
Q

Describe stage 5 CKD.

Describe the care for this stage.

A

GFR = <15ml/min/1.73m2

  • management of non-nephrology issues
  • intensive interdisciplinary monitoring
  • initiation of renal replacement therapy
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6
Q

What is the afferent arteriole?

A
  • arteriole where blood enters the glomerulus

- NSAIDS can cause acute kidney injury by inhibiting vasodilation

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7
Q

What is the efferent arteriole?

A
  • arteriole in which blood leaves the glomerulus

- ACE inhibitors and ARBs can cause acute kidney injury by inhibiting vasoconstriction

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8
Q

What part of the nephron reabsorbs 80% of the glomerular ultrafiltrate?

A

The proximal convoluted tubule

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9
Q

What does the proximal convoluted tubule reabsorb?

Secrete?

A
  • nutrients
  • electrolytes (Na+, K+, Cl-, HCO3-, Ca2+, PO4-)
  • rickets if Ca2+ isn’t properly absorbed
  • creatinine
  • uric acid
  • other drugs
  • some drugs can make Cr high when they shouldn’t be
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10
Q

What is the primary role of the loop of Henle?

What type of diuretics work here?

A
  • reabsorption of water, Na+, Cl- and Mg2+

- loop diuretics work here to block the reabsorption of water and Na+ in the ascending loop of henle

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11
Q

What is the role of the distal convoluted tubule?

What type of diuretics work here?

A
  • Reabsorb Na+ and water
  • Secrete K+, H+ and phosphorus
  • Thiazide diuretics work here
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12
Q

What is the role of the collecting duct?

A
  • To collect the urine
  • reabsorb Na+
  • secrete K+ (dependent on aldosterone)
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13
Q

How does ADH affect urine concentration?

A
  • It affects H20 permeability in the collecting duct
  • high ADH = concentrated urine
  • low ADH = diluted urine
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14
Q

What is urea?

A
  • a waste product of protein metabolism
  • blood test can show levels
  • only a general indicator of renal function (since it is reabsorbed by kidneys and can be affected by other diseases)
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15
Q

What happens to water/Na+ in CKD patients?

A
  • edema/swelling

- because tubules are not able to decrease reabsorption

16
Q

What happens to K+ in CKD patients?

A
  • increase in blood (hyperkalemia)

- distal tubule not able to increase secretion

17
Q

What happens to phosphorus levels in CKD patients?

A
  • increase in blood (hyperphosphatemia)
  • proximal tubule not able to decrease reabsorption
  • distal tubule not able to increase excretion
18
Q

What happens to magnesium levels in CKD patients?

A
  • increase in blood (hypermagnesemia)

- loop of Henle not able to decrease reabsorption

19
Q

What do the kidneys do when the pH of the blood decreases (acidosis)?

A
  • kidneys reabsorbs bicarbonate and produces more bicarbonate
  • bicarbonate combines with H+ to increase pH to normal levels
20
Q

What does the kidneys do when the blood pH increases?

A
  • bicarbonate is secreted instead of reabsorbed

- decreased bicarbonate will increase the H+ concentration and lower pH levels of the blood

21
Q

What do the kidneys do when BP is low?

A
  • The RAAS is activated
  • renin is released by kidneys
  • angio 1 converted to angio II be ACE
  • angio II stimulates aldosterone production, vasoconstriction and thirst
  • water and Na+ are retained
  • BP increases
22
Q

What causes anemia?

A

In CKD, erythropoietin production decreases and RBCs/hemoglobin will decrease

23
Q

What is pseudo renal failure?

A
  • increase in sCr due to decrease secretion in the tubules

- falsely elevated

24
Q

What is pre-renal renal failure?

A
  • decreases blood flow to kidney
  • decreases GFR
  • most common acute kidney injury

Caused by:

  • intravascular fluid depletion
  • decline in effective blood volume
  • decrease pressure in glomerulus
25
Q

What is intrinsic AKI renal failure?

A
  • structural damage to kidney
  • effects either glomerulus or tubule
  • acute tubular necrosis, glomerulonephritis & acute interstitial nephritis
26
Q

What is acute tubular necrosis?

A
  • ischemia in the kidneys causing cell damage to the tubules
27
Q

What is acute interstitial nephritis?

A
  • inflammatory disorder of the renal interstitium

- caused mostly by drugs

28
Q

What is glomerulonephritis?

A
  • stimulation of the immune system leading to inflammation of the glomerulus
  • caused by DNA, protein, viruses and bacteria that stimulate immune system
29
Q

What is post-renal AKI renal failure?

A
  • obstruction of urine flow

Caused by:

  • kidney stones
  • bladder tumor or obstruction
  • urethral stricture/tumor
  • crystals in tubules caused by certain drugs
30
Q

What is the cockcroft gault formula for CrCl?

A

CrCl (ml/min/72kg) = ((140-age)(88.4) x (0.85 if female))/sCr

31
Q

What is normal sCr

A

80-100 umol/L

32
Q

What could a serum urea to Cr ratio >70 indicate?

A

dehydration

Patho (15 decks)

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