CKD Flashcards
CKD
a slow and progressive loss of
renal function
Loss of function in CKD is reversible (T/F)
false. irreversible
CKD injury site
On glomeruli.
Does glomeruli regenerate
Nopesy
Histological features on CKD
o Shrunken kidneys
o Sclerotic glomeruli
o Fibrotic changes
Kidneys may be normal or enlarged in CKD patients with
DM
PCKD
Amyloidosis
SLE
Infections
NSAIDs
Obstructive uropathies
Casuses of CKD
DM
HTN
GN
SLE
PCKD
Amyloidosis
CKDu (CINAC)
Obstructive uropathies
Drugs
Snake bites
Sx of CKD
Anaemia, pallor
Nausea, vomiting
Pruritus
Pigmentation
Pleural effusion
Pericardial effusion
Peripheral neuropathy
Fluid overload and it features
Earliest Sx of CKD
Nocturia
GFR value when Sx starts appear in CKD
GFR<20
Type of breathing in severe metabolic acidosis
Kussamaul’s breathing
Dx of CKD
Suspect based on
o underlying disease
o time frame for disease manifestation
Confirm using biochemistry/radiology
o high serum creatinine
o abnormal phosphate and calcium levels
o anaemia
o small kidneys on ultrasound
Stages of CKD
1 (GFR 90-120)
2 (GFR 60-90)
3 (GFR 30-60)
4 (GFR 15-30)
5 (GFR < 15) (ESRD)
Even stages 3, 4 or 5 of CKD can be Asx (T/F)
True
Treatment protocol in stage 1-5 in CKD
o Measures to retard disease progression
Treatment protocol in stage 3-5 in CKD
o Measures to reduce symptoms
Final Mx step for CKD stage 5
RRT
Measures to retard progression in CKD
Reduce Intra renal BP
Reduce Systemic BP
Reduce RAS pathway activation
Block AT/aldosterone/PGE2….TGF beta
Reduce Proteinuria
Reduce Cytokine release
A multiple risk modification is required for CKD (T/F)
True
Measures for symptomatic management for CKD
Furosemide
Nifedipine
Domperidone
1 alpha calcidol
Erythropoietin
Emollient ointment
Calcium carbonate
Sodium bicarbonate powder
Polystyrene resins
Benefit of giving anti- hypertensives for CKD
Reduces fluid overload
Benefit of giving 1- alpha calcidol in CKD
To correct hypocalcemia
EPO is a IM injection (T/F)
False. SC
Benefit of giving emollients of CKD
Pruritis
When will the Cr levels start to increase in CKD
GFR is around 60
Histological finding in Kidneys in CKD
Loss of cortico- medullary demarcation
Reason for hypocalcemia in CKD
Vitamin D undergoes 1- alpha hydroxylation in the kidney (Become 1,25 (OH)2 vit D)
The hydroxylation is affected so Ca2+ levels will be reduced. (Vitamin D increases Ca2+ levels)
Why is there increased Phosphate levels in CKD
Coz they are not excreted by the kidneys
Why is there a secondary hyperparathyroidism in CKD
hypocalcemia stimulates the parathyroid gland causing increased PTH
Result of secondary hyperparathyroidism in CKD
PTH will reduce phosphate levels and increase calcium levels
Tertiary hyperparathyroidism in CKD
In CKD because the parathyroid gland is constantly stimulated, at some point the gland will autonomously stimulate
Calcium and phosphate levels in CKD
Increased Calcium and Phosphate levels
Why is Reducing RAS pathway activation necessary in CKD
the remaining active glomeruli will try to increase the GFR by activating RAAS and vasoconstricting the efferent arterioles. In the long run this is detrimental
Why is there a cytokine release in CKD
proteinuria causes inflammation at the glomeruli causing a cytokine release
Why is EPO given to CKD patients
CKD patients have normochromic normocytic anemia.
o Loss of appetite
o Blood loss from GIT
o Erythropoietin deficiency
o Bone marrow toxins are retained
o Haemolysis during dialysis
methods of EPO administration
IV or SC
Mx of Anemia of renal disease
o Look at blood picture
o Assess iron stores/folate/B 12
o Erythropoietin replacement ± Fe/
Folate/ B12
Measures of RRT
Dialysis
o Haemo-dialysis
o Peritoneal-dialysis
Transplant
o Cadaveric
o Live
Related
Non-related
