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Pathophysiology > CKD I > Flashcards

CKD I Flashcards

1
Q

GFR

A

glomerular filtration rate. Volume of blood filtered by the glomerulus each minute

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2
Q

what is the normal adult GFR range?

A

100-125 mL/min

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3
Q

How can we estimate the GFR?

A

Using different equations such as creatinine clearance

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4
Q

what is the equation for creatinine clearance?

A

= [(140-age)x88.4x(0.85 if female)]/serum creatinine (sCr)

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5
Q

why is creatinine clearance important?

A

Since it is freely filtered by the glomerulus, it can be used as a marker of glomerular filtration rate (GFR)

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6
Q

What happen to serum creatine levels when renal functioning is impaired?

A

become elevated

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7
Q

what drugs can cause acute kidney injury by inhibiting vasodilation of the afferent arteriole?

A
  1. NSAIDS
  2. Cox-2 inhibitors
  3. Cyclosporine
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8
Q

what drugs can cause acute kidney injury by inhibiting vasoconstriction of the efferent arterioles?

A
  1. angiotensin converting enzyme inhibitors (ACE-I)

2. angiotensin II receptor blockers (ARB)

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9
Q

T or F: We want to constrict the afferent and dilate the efferent

A

FALSE; we want to DILATE the afferent and CONSTRICT the efferent

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10
Q

what is reabsorbed at the proximal tubule?

A
  1. Nutrients
    (a) glucose
    (b) amino acids
  2. Electrolytes
    (a) Na+
    (b) K+
    (c) Cl-
    (d) bicarbonate (HCO3-)
    (e) Ca2+
    (f) phosphorous (PO4-)
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11
Q

What is secreted at the proximal tubule?

A
  • creatinine
  • uric acid
  • certain drugs
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12
Q

What is the role of the Loop of Henle?

A

reabsorption of Na+, Cl-, water and Mg

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13
Q

What does the distal convoluted tubule reabsorb?

A
  • Na+ and water
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14
Q

What does the distal convoluted tubule secrete?

A

K+, H+ and phosphorus

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15
Q

what does the collecting duct reabsorb?

A

Na

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16
Q

What does the collecting duct secrete?

A

K+ , which is dependent on aldosterone

17
Q

which is a more sensitive marker of kidney function, Urea or creatinine ?

A

creatinine

18
Q

Why is concentration of Urea clinically important?

A

serum urea to creatinine ratio > 70 may indicate dehydration

19
Q

What happens to electrolytes in patients with chronic kidney disease?

A
  1. sodium/water –> edema and swelling due to inability to decrease reabsorption
  2. K+ increases in the blood due to inability to increase excretion from distal tubule
  3. Phosphorus increases in blood because not able to decrease reabsorption in proximal tubule and increase excretion from distal tubule
  4. Magnesium increases in the blood because not able to decrease reabsorption in the loop of henle
20
Q

what do the kidneys do when it is experiencing acidosis?

A

reabsorb all the filtered bicarbonate into the extracellular fluid

21
Q

what do the kidneys do when it is experiencing alkalosis?

A

the kidneys cannot reabsorb bicarbonate so it is excreted instead

22
Q

when is renin released?

A

when the juxtaglomerular cells - located in the walls of the arterioles are stimulated (responding to changes in circulating blood volume and pressure)

23
Q

hyperkalemia

A

increased K in the blood

24
Q

hyperphosphatemia

A

increased phosphorous in the blood

25
Q

erythropoietin (EPO)

A

stimulates the production of red blood cells in the bone marrow

26
Q

How does the kidney know to secrete EPO?

A

when the oxygen levels fall below a certain level the kidneys respond by secreting EPO

27
Q

What happens in CKD in regards to EPO?

A

EPO production goes down and the patient’s RBCs/hemoglobin decrease = anemia

28
Q

What are the types of renal failure?

A
  1. Pseudo
  2. pre-renal
  3. intrinsic
  4. post renal
29
Q

Pseudo renal failure

A

serum creatinine levels increase due to blocking of renal tubular secretion of creatinine. This is not “true” renal failure because drugs are blocking the secretion of creatinine

30
Q

pre-renal renal failure

A

due to a decreased blood flow to the kidneys and hence a decreased glomerular filtration rate

31
Q

intrinsic renal failure

A

due to structural damage to the kidney affecting either the glomerulus or the tubules; damage to the kidney itself

32
Q

post-renal renal failure

A

obstruction to urine flow beyond the kidneys; something happening in bladder or ureter

33
Q

what is the most common cause of renal failure ?

A

pre-renal failure which is 50-60% of all cases

34
Q

what are some reasons why pre-renal failure can occur?

A
  1. intravascular volume depletion
  2. decline in effective blood volume
  3. decreased pressure in glomerulus due to drugs that vasoconstrict the afferent arteriole and vasodilate the efferent arteriole
35
Q

what is Acute Tubular Necrosis (ATN)?

A

ischemia in the kidney producing cell damage to the tubules; leads to intrinsic renal failure. Due to medication induced causes

36
Q

What is Acute Interstitial Nephritis?

A

inflammatory disorder of the renal interstitium (“allergic reaction”) . Caused by drugs

37
Q

What is glomerulonephritis?

A

results from the stimulation of the immune system leading to inflammation of the glomerulus

38
Q

What are 3 causes of Intrinsic AKI

A
  1. Acute tubular Necrosis
  2. Acute interstitial Nephritis
  3. glomerulonephritis
39
Q

what is the cause of Post-renal AKI?

A
  1. Kidney stones
  2. bladder timor or obstruction
  3. urethral stricture/tumor
  4. crystal deposition in renal tubules (which can occur from certain drugs)

Pathophysiology (7 decks)

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