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Renal Exam 2 > CKD > Flashcards

CKD Flashcards

1
Q

Define CKD

A

A spectrum of different pathophysiologic process/diseases associated with abnormal kidney function and a progressive decline in GFR

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2
Q

Define Chronic Renal Failure

A

Irreversible reduction in nephron number, corresponds to CKD stages 3-5

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3
Q

Define ESRD

A

Accumulation of toxins, fluid and electrolytes normally excreted by the kidney results in the uremic syndrome

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4
Q

Stage 0

A

GFR >90 with RF for CKD

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5
Q

Stage 1

A

GFR > 90 with kidney damage/malfunction (persistent proteinuria, abnormal urine sediment, abnormal blood/urine chemistry, abnormal imaging studies

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6
Q

Stage 2

A

GFR 60-89

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7
Q

Stage 3

A

GFR 30-59

Symptoms are present

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8
Q

Stage 4

A

GFR 15-29

Symptoms are present

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9
Q

Stage 5

A

GFR less than 15

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10
Q

CKD Pathophysiology

A

1) Mechanisms specific to the etiology (glomerulonephritis, tubulointerstitial disease, kidney development)
2) Progressive reduction of renal mass (hyperfiltration and hypertrophy of remaining nephrons)

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11
Q

Decreased number of nephrons leads to

A

Hypertrophy and hyperfiltration –> increased pressure and flow –> distortion of glomerular architecture/sclerosis and drop out of remaining nephrons –> destruction of parenchyma

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12
Q

What can cause hypertrophy and hyperfiltrations

A

Vasoactive hormones
Cytokines
Growth factors
RAS

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13
Q

What can cause distortion of glomerular architecture/sclerosis and drop out of remaining nephrons?

A

RAS and TGF-beta

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14
Q

What are the consequences of hyperfiltration

A

Fibrosis and compression of the endothelial cells –> can’t function –> more nephrons are removed –> irreversible process of damage begins

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15
Q

Common risk factors for CKD

A 
HTN and DM
Lupus
Age
Previous AKI
Genes
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16
Q

GFR normal

A

120 mL/min per 1.73 m^2

Lower in women than in men

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17
Q

Mild elevation in SCr

A

Signifies substantial reduction in GFR

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18
Q

Mild elevation in SCr

A

Signifies substantial reduction in GFR

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19
Q

Microalbuminuria refers to

A

the excretion of amounts of albumin too small to detect by regular urinary distick

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20
Q

Monitoring nephron injury

A

GFR
Albuminuria (24 hr collection)
Protein-to-creatinine ratio

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21
Q

Stage 1 and 2 Symptoms

A

None related to decreased GFR but may be some related to the renal disease (edema, HTN)

22
Q

Stage 3 and 4 symptoms

A

Anemia
Fatigability
Decreasing appetite with progressive malnutrition
Calcium, phosphorus, sodium, potassium, water, acid-base homeostatis and mineral regulating hormone abnormalities

23
Q

Stage 5 Symptoms

A

Toxins accumulate –> disturbance in their daily living, well being, nutrional status, water/electrlyte homeostatis

24
Q

Stage 5 leads to

A

Uremic syndrome

25
Q

Leading etiologies of CKD

A

DM II
Glomerulonephritis
Hypertensive nephropathy
Polycystic kidney disease

26
Q

Pathophysiology of uremia

A

Accumulation of toxins that undergo renal excretion
Loss of other renal functions (fluid homeostatis and hormone regulation)
Systemic inflammation and its vascular and nutritional complications (elevated protein C)

27
Q

Surrogate markers of real toxins are:

A

Urea and creatinine

28
Q

Uremia leads to

A

disturbances in the function of virtually every organ system

29
Q

Severy complications and consequences of CKD

A

Cardiovascular
Hematologic (no erythropoietin)
Ca, PO4 and bone (replacement with fibrosis)

30
Q

Define metabolic acidosis

A

Abnormally high level of acid and low bicarbonate in blood and other tissues resulting from inability to excrete protons and reabsorb bicarb

31
Q

Hypervolemia

A

Na & H2O retention
Extracellular fluid expansion –> HTN and edema
HTN leads to nephron injury acceleration
(no RAAS activation so retention)

32
Q

Hypovolemia

A

Na and H2O leads to extrarenal fluid loss +

Impaired renal conservation leads to acute-on-chronic renal failure

33
Q

Acute on chronic

A

Inability to concentrate the urine leads to increased water loss and decreased CO

34
Q

Things that lead to hyperkalemia

A 
Protein catabolism
GI hemorrhage
ACEi
ARBs
Transfusion
Hemolysis
Diuretics
35
Q

HyperK is seen in

A

DM

Obstructive and sickle cell nephropathy

36
Q

Ischemic cardiovascular disease types

A

Occlusive coronary disease
Cerebrovascular disease
Peripheral vascular disease

37
Q

Normocytic, normochromic anemia

A 
Insufficient erythropoietin
Iron deficiency
Impaired iron utilization
Severe hyperparathyroidism (bone marrow fibrosis)
Shortened RBC survival
38
Q

Abnormal hemostatis =

A

Prolong bleeding time

Thromboembolism (nephrotic syndrome - loss of anticoagulants)

39
Q

Bone manifestations of CKD

A

High bone turnover with increased PTH levels

Low bone turnover with low or normal PTH

40
Q

Bone manifestations of CKD

A

High bone turnover with increased PTH levels

Low bone turnover with low or normal PTH

41
Q

High bone turnover with increased PTH levels =

A

Osteitis fibrosa cystica

42
Q

Low bone turnover with low or normal PTH =

A

Adynamic bone disease (PTH suppression)

Osteomalacia

43
Q

Decreased calcium leads to

A

Bone :Increased bone absorption and Ca efflux
Kidney and intestine: Increased Ca reabs and decreased PO4 reabs

Bone and Kidney due to increased PTH
Intestine due to increased dihyroxycholecalciferol

44
Q

Too much calcium =

A

Thyroid gland releases calcitonin which stimulates Ca salt deposit in bone

45
Q

Too little calcium =

A

Thyroid gland releases PTH which tells osteoclast to degrade bone matrix to release Ca into blood

46
Q

Renal osteodystrophy

A

Increased osteoclastic bone resorption (osteitis fibrosa cystica like disease)
Osteomalacia (decreased matrix mineralization)
Adynamic bone (reduced volume and mineralization

47
Q

Secondary hyperparathyroidism Patho

A

Declining GFR leads to reduced PO4 excretion
PO4 stimulates increased PTH and growth of parathyroid gland
Decreased Ca leads to PTH production
Low calcitriol has a direct effect on PTH transcription
Metabolic Acidosis stimulates bone resorption
- GFR

48
Q

FGR-23 (phosphatonin)

A

RF for left ventricular hypertrophy and mortality in dialysis pts
Tries to keep normal phosphorus levels
Increases early in CKD and promotes PO4 excretion

49
Q

CKD has

A

Hypocalcemia and hyper PO4

50
Q

CKD has

A

Hypocalcemia and hyper PO4

51
Q

Consequences of CKD

A 
Bone pain and fragility
Brown tumor
Compression syndromes
Erythropoietin resistance
PTH related muscle weakness and fibrosis of cardiac muscles

Renal Exam 2 (10 decks)

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