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Clin Med II > CKD and Nephrotic > Flashcards

CKD and Nephrotic Flashcards

1
Q

Decreased kidney function OR kidney damage for 3+ months is determined what?

A

Chronic kidney disease (CKD)

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2
Q

What is the hallmark of CKD?

A

Declining GFR (< 60)

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3
Q

What establishes risk for progress and complications of CKD?

A

GFR and albuminuria staging

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4
Q

Pt presents w GFR ≥ 90. What stage of CKD are they?

A

Stage 1

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5
Q

Pt presents w GFR 45-59. What stage of CKD are they?

A

Stage 3a

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6
Q

Pt presents w GFR 30-44. What stage of CKD are they?

A

Stage 3b (refer if GFR <30 to determine cause)

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7
Q

Pt presents w GFR < 15. What stage of CKD are they?

A

Stage 5

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8
Q

Based on a urine albumin-to-creatinine ratio, at what stage should you be concerned for kidney damage?

A

≥ 30 mg/g

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9
Q

The following is the pathogenesis for what kidney disease? Irreversible destruction of nephrons → compensatory hypertrophy → overwork injury → glomerular sclerosis & interstitial fibrosis

A

CKD

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10
Q

The pathogenesis of CKD ultimately leads to abnormal production and metabolism of what 2 things?

A

Erythropoietin and calcitriol

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11
Q

What are the leading causes of kidney failure? (2)

A

DM and HTN

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12
Q

What syndrome is characterized by fatigue, malaise, pericarditis, and encephalopathy?

A

Uremic syndrome

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13
Q

With CKD, HTN → inc PTH → inc phosphorus → acidosis → hyperkalemia ultimately leads to what?

A

Uremic syndrome

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14
Q

What condition involves a spectrum of bone disorders and is clinically detectable at stage 3-4 of CKD?

A

Mineral and bone disorder

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15
Q

In mineral and bone disorder seen with CKD, ↓ GFR, ↑ phosphorus, and ↓ calcium lead to what secondary condition?

A

↑ PTH (secondary parathyroidism)

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16
Q

Infection, urinary tract obstruction, HF (↓ renal perfusion), and nephrotoxic agents might be considered reversible or irreversible causes of CKD?

A

Reversible

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17
Q

On renal US you note small kidneys bilaterally. What should you be concerned for?

A

CKD

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18
Q

What is the tx for CKD? (3)

A
  1. Identify/ tx underlying cause/ reversible factors 2. Slow disease progression 3. Renal Replacement Therapy (RRT) for ESRD
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19
Q

Target BP in CKD pts w/o proteinuria should be what?

A

< 140/90

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20
Q

Target BP in CKD pts w/ proteinuria should be what?

A

< 130/80

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21
Q

What drug classes are used in the treatment of CKD to control BP and have a renoprotective effect and slow proteinuric CKD?

A

ACE-I/ARBs (also should follow a low sodium diet)

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22
Q

When are ACE-I/ARBs contraindicated in the tx of CKD?

A

BIL renal artery stenosis

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23
Q

When are ACE-I/ARBs considered harmful and therefore should not be used in the treatment of CKD?

A

If acute ↓ GFR & hyperkalemia (AKI)

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24
Q

The following are indications for what CKD treatment? Uremic sx Fluid overload to diuresis Refractory hyperkalemia, acidosis, hyperphosphatemia

A

Dialysis

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25
Q

What time of dialysis involves a semipermeable membrane between blood & dialysate?

A

Hemodialysis

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26
Q

What is a complication of hemodialysis?

A

Hypotension

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27
Q

What time of dialysis involves dialysate into peritoneal cavity, with the peritoneal membrane as the dialyzer (used to filter waste)?

A

Peritoneal

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28
Q

What is a complication of peritoneal dialysis?

A

Peritonitis

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29
Q

What is the tx of choice for ESRD?

A

Kidney transplant

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30
Q

Chronic Tubulointerstitial Diseases of the Kidney can all lead to what?

A

CKD

31
Q

Interstitial scarring and tubular atrophy leading to progressive renal sufficiency is characteristic of what set of conditions?

A

Chronic Tubulointerstitial Diseases of the Kidney

32
Q

What part of the kidney is spared by Chronic Tubulointerstitial Diseases of the Kidney?

A

Glomeruli

33
Q

Obstructive uropathy, reflux nephropathy and analgesics are the most common causes of what?

A

Chronic Tubulointerstitial Diseases of the Kidney

34
Q

Upon exam you note polyuria, hyperkalemia +/- proteinuria and broad waxy casts on urinalysis… what should you be concerned about?

A

Chronic Tubulointerstitial Diseases of the Kidney

35
Q

What is the treatment for Chronic Tubulointerstitial Diseases of the Kidney? (5)

A
  1. Identify underlying 2. Med management 3. Relief of obstruction 4. Withdrawal of analgesics 5. Refer
36
Q

What condition is characterized by prolonged/recurrent obstruction of urinary tract leading to chronic reduction in GFR and impaired tubular function?

A

Obstructive Uropathy

37
Q

Pt presents with change in urine output, HTN, hematuria, ↑ serum creatinine, +/- pain and on UA you note hematuria, pyuria, bacteriuria (bland). What condition might you be concerned for?

A

Obstructive Uropathy

38
Q

What might be seen on US of a pt w/ obstructive uropathy?

A

Mass, hydroureter, hydronephrosis

39
Q

What condition is the result of vesicoureteral reflux (VUR) or other urologic anomalies of early childhood?

A

Reflux Nephropathy

40
Q

What condition has the following pathogenesis? Retrograde urine into interstitium → inflammatory response → fibrosis

A

Reflux Nephropathy

41
Q

Reflux Nephropathy is often dx in young children w/ hx of what?

A

Recurrent UTIs

42
Q

What 2 diagnostic imaging studies should be performed on a pt with reflux nephropathy?

A

RUS (scarring & hydronephrosis) VCUG (VUR/lower urinary tract anatomy)

43
Q

Analgesic Nephropathy is defined as CKD due to what?

A

Long-term analgesic use (Acetaminophen, NSAIDS)

44
Q

What might you see on CT scan of a pt with Analgesic Nephropathy?

A

Renal papillary necrosis and calcification

45
Q

What is the term for a group of diseases that present primarily w/ proteinuria and bland urine sediment?

A

Nephrotic spectrum

46
Q

What condition is characterized as noninflammatory damage to glomerular capillary wall?

A

Nephrotic Syndrome

47
Q

Eval of a pt being evaluated for kidney disease shows the following lab values/ PE… what should you be concerned for? Proteinuria > 3.5 g/d) Hypoalbuminemia Hyperlipidemia PE: edema, ascites

A

Nephrotic Syndrome

48
Q

On urine microscopy you note foamy, oval fat bodies. What should you be concerned for?

A

Nephrotic Syndrome

49
Q

Complications of what condition include hypercoagulability, infection, protein malnutrition, vit. D loss, hypocalcemia and anemia?

A

Nephrotic Syndrome

50
Q

What is the main tx for Nephrotic Syndrome?

A

Diuretics/ fluid restriction (also immunosuppressive therapy and nephro referral)

51
Q

What are the 3 primary diseases of the Nephrotic Syndrome?

A

Minimal change disease (MCD) Membranous nephropathy Focal segmental glomerulosclerosis (FSGS)

52
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease (MCD)

53
Q

What primary Nephrotic Syndrome disease often follows a URI and is considered to be a hypersensitivity rxn?

A

Minimal change disease (MCD)

54
Q

Pt presents with hx of a sudden onset “puffy appearance” and you note podocyte foot process fusion on electron microscopy, what should you be concerned for?

A

Minimal change disease (MCD)

55
Q

What is 1st line tx for Minimal change disease (MCD)?

A

Prednisone

56
Q

What is the likely cause of primary membranous nephropathy?

A

Likely immune-mediated

57
Q

What primary Nephrotic Syndrome has a gradual development and places pts at a higher risk of hypercoagulable state?

A

Membranous nephropathy

58
Q

Membranous nephropathy is dx with serology or biopsy. How is it treated?

A

Supportive, +/- immunosuppressive agents, transplant

59
Q

What is one of the most common causes of primary glomerular diseases in adults?

A

Focal segmental glomerulosclerosis (FSGS)

60
Q

What kidney condition is considered a histologic pattern of kidney injury and NOT a specific disease entity?

A

Focal segmental glomerulosclerosis (FSGS)

61
Q

What populations are at greater risk for and are likely to have a poorer outcome if dx with focal segmental glomerulosclerosis (FSGS)?

A

AA’s

62
Q

What primary nephrotic syndrome involves glomerular injury resulting from podocyte damage, along with sclerosis in parts of 1+ glomerulus?

A

Focal segmental glomerulosclerosis (FSGS)

63
Q

What are the primary and secondary causes of Focal segmental glomerulosclerosis (FSGS)?

A

Primary = idiopathic Secondary = overworked

64
Q

Besides supportive tx, what are the txs for primary and secondary Focal segmental glomerulosclerosis (FSGS)?

A

Primary = immunosuppressive Secondary = disease-specific tx

65
Q

What are the 2 secondary diseases of the Nephrotic Syndrome?

A

Diabetic nephropathy Amyloidosis

66
Q

What is the most common cause of ESRD in the U.S.?

A

Diabetic nephropathy

67
Q

What condition is characterized as structural and functional changes due to HTN with a peak incidence of hyperglycemia seen 10-20 yrs after onset of disease and may also involve retinopathy?

A

Diabetic nephropathy

68
Q

What is the treatment for diabetic nephropathy? (3)

A
  1. Strict glycemic/ BP control 2. ACE-I/ ARBs, statin therapy 3. Dialysis/ transplant when indicated
69
Q

What disease is characterized as a deposition of amyloids in the glomerulus?

A

Amyloidosis

70
Q

Are monoclonal light chains indicative of AL amyloidosis or AA amyloidosis?

A

AL amyloidosis

71
Q

Is chronic inflammatory disease (RA) or infection indicative of AL amyloidosis or AA amyloidosis?

A

AA amyloidosis

72
Q

What labs should be ordered for a pt with amyloidosis?

A

SPEP and UPEP

73
Q

What is the treatment for amyloidosis?

A

Tx underlying cause, refer to nephro

Clin Med II (12 decks)

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