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Chronic Disease > CKD > Flashcards

CKD Flashcards

1
Q

What are the differences between acute CKD?

A

Long lasting (>3 months)
Less severe
Can progress to severe disease

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2
Q

What are the functions of the kidney?

A

Remove waste products
Regulate ions in blood (K+, Ca2+, Na+)
Regulate water levels
Hormone production (EPO, vit D activation)

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3
Q

What is the functional unit of the kidney?

A

Nephron - 10^6 - Glomerulus, PCT, LoH, DCT, Collecting duct

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4
Q

What are the layers of the membrane between the glomerulus capillaries and bowmen capsule?

A

Fenestrated endothelium cells
Basesment membrane
Filtration slits in epithelial cells
Podocytes

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5
Q

What controls the rate of filtration in the glomerulus?

A

Afferent and Efferent BP
Increase Efferent BP (vasoconstriction) causes build of up of pressure in the glomerular capillaries and increases the rate of ultrafiltration

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6
Q

What can cause vasoconstriction in the efferent arteriole?

A

H20
Salt concentration
Prostaglandins
Angiotensin

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7
Q

What are the components of the membrane that create the negative charge?

A

Fenestrated endothelium - Podocalyxin
Basesment - Heparin sulphate prostoglycans
Podocytes - Podocalyxin

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8
Q

What is the rough limit of size of molecules to pass through the glomerulus?

A

50-60,000 mW

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9
Q

What are some examples of molecules filtered?

A 
H20
K+
Urea
Inulin
Creatinine
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10
Q

What is not filtered?

A

Serum albumin

RBC

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11
Q

What is the measurement for measuring kidney function?

A

GFR = ml/min/1.73m2

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12
Q

How can we measure GFR?

A

Exogenous solutes - Inulin and Chromum51EDTA (Expensive, slow, exposure to radiation)

Endogenous solute - Creatinine

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13
Q

What is creatinine?

A

Produced in the liver, converted from creatine
Muscle stores around 100g creatine (as creatine phosphate - high energy phosphate donor)
Rate of conversion depends on liver function, muscle mass and muscle catabolism
Freely filtered at the glomerulus

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14
Q

What is the problem with measuring creatine clearance?

A

Requires measurement of urine over a 24 hour period – impractical

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15
Q

What is the problem with using plasma creatine as a surrogate measure for GFR?

A

Poor at extreme measures
Doesnt take into account muscle mass
Creatine is secreted by the tubules so is not a direct measure of GFR
Affected by exercise and protein intake

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16
Q

What are the validated formulas used to measure GFR?

A

Cockcroft-Gault - Gender, Age, Weight
MDRD (eGFR) - gender, age, ethnicity
CKD-EPI (Creatinine and CystatinC measurements)

17
Q

What other measurements can we use to determine kidney health?

A

Proteinuria (albumin/creatinine ratio)
Heamaturia
Albumuria (24 hour urine measurement)

18
Q

What defines CKD stages?

A

NKF-KDOQI (Kidney disease outcomes quality initiative)

19
Q

What are the stages of CKD?

A

Stage 1 - Haematuria, Proteinuria, normal GFR (>90)
Stage 2 - Haematuria, Proteinuria, slightly reduced GFR (60-89)
Stage 3a - reduced GFR (45-59), Stage 3b (31-44)
Stage 4 - vastly reduced GFR (16-30)
Stage 5 - kidney failure (>15ml/min/1.73m2)

20
Q

What are the stages of albuminuria?

A

A1 - <30
A2 - 31-299
A3 - >300

21
Q

What are the advantages of the introduction of the NKF-KDOQI?

A

Standaradise CKD diagnosis around the world - increased comparisons between epidemiology studies
Increase awareness
Increase need for early diagnosis

22
Q

What are the downside of the NKF-KDOQI?

A

Formula to calculate GFR not completely accurate - vary greatly with age, gender, ethnicity, pregnancy, extreme weights, diabetics
MDRD (eGFR) 30% of patients will get a result out by >30% - overestimation of CKD

23
Q

What are the prevalence stats for CKD in the UK?

A

10.6% women
5.8% men
around 3 mill have CKD
60,000 have Stage 5 and require treatment - 19 per day
RRT - Dialysis - 500 mil, Transplant - 225 mil (2010)

24
Q

What are the consequences of CKD?

A

Hyperkalaemia - High K - Arrthymia
Acidosis - Azotemia (urea) - weight loss, fatigue, nausea, asterixis
Hypocalcaemia - reduced activation of VitD - reduced calcium in blood - secondary hyperparathyroidism - calcium from bones - pain
Hyperphosphataemia - increased PO4 - leads to hypocalcaemia
Renal Anaemia - reduced EPO - fatigue, weight loss
Fluid retention - oedema
Hypertension - increased renin - increased BP

Chronic Disease (12 decks)

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