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Medicine > CKD RENAL > Flashcards

CKD RENAL Flashcards

1
Q

Ckd is characterized b

A

IFTAGS

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2
Q

Clinical definition of ckd

A

Abnormalities of kidney str present for more than 3 months with implications for health
Gfr less than 60 ml/min
Albuminuria more than 30 mg / 24 hr

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3
Q

CTID

Primary CTID features are

A

IF TA
IF when more than 5 % of cortical area is connective tissue
TA when diameter drops by 50%

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4
Q

Most potent fibrogenic cytokine which is also responsible for ctid

A

Tgf beta

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5
Q

TGF BETA sources are

A

Pericytes converted to fibroblast
Fibroblast progenitors activation (Gli -I cells)
Hypoxia triggers fibrosis

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6
Q

Balkam nephropathy occurs due to

A

Toxin -aristolochic acid chinese herbal poisoning

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7
Q

Ouch ouch nephropathy occurs due to

A

Cadmium

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8
Q

Hyperuricemia and htn due to lead is k a

A

Saturnine gout

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9
Q

Drugs responsible for ctid

A

Lithium

Calcineurin inhibitors

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10
Q

Vacuolation of pct >dct due to

A

Hypokalemia

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11
Q

Metabolic causes of ctid

A

Hypokalemia
Hypercalcemia
Hyperoxaluria
Hyperuricemia

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12
Q

Rate of fall in gfr in ctid

A

2-4ml/min/yr

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13
Q

Mcc cause of Anemia in cld is ctid why

A

Because erythropoetin is produced from peritubular interstitial fibroblast and fibrosis leads to very low levels of erythropoetin

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14
Q

Defective concentration capacity of kidney lead to

A

Polyuria nocturia

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15
Q

Proximal tubular dysfunction leads to

A

Fanconi syndrome rickets like feature

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16
Q

Salt wasting syndrome is seen in

A

Ctid

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17
Q

Type 4 RTA aka pseudohypoaldosteronism lead to
Potassium levels?
Urine output

A

Hyperkalemia which is disproportionate to degree and duration of ckd
And nephrogenic diabetes insipidus

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18
Q

Salt sensitive hypertension occurs due to

A

Hypertrophy of jga as it is last to fibrose

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19
Q

Microcystic changes in DT without interstitial inflammation

A

Lithium

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20
Q

Characterstic changes in calcineurin inhibitors toxicity

A

Patchy interstitial fibrosis in striped pattern

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21
Q

Afferent arteriolar hyalinosis is seen in

Afferent and efferent arteriolar hyalinosis is seen in

A

Calcineurin inhibitors

Diabetes

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22
Q

Treatment of ctid

A

Transplant

Doesn’t recur post transplant

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23
Q

Characteristics feature of IgG4 related kidney disease

A

Lymphoplasmocytic infiltration of any organ

Tumifactive storiform fibrosis

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24
Q

Bird eye /maple wood grain pattern is seen in

A

IgG4 related kidney disease

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25
Q

Autoimmune pancreatitis salivary gland swelling ctid

Reidel thyrditis are c/f of

A

IgG4 related kidney disease

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26
Q

Incidence of ckdu is seen in

A

Working age male
(Agricultural )
Heat stress

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27
Q

Areas of ckd u belt

A

El salvador
Egypt
Sri lanka india

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28
Q

Mesoamerican nephropathy is seen in

A

Sugar cane worker

Also known as heat stress nephropathy

29
Q

Factors affecting ckd u

A

Water high fluoride, cyanobacterial toxin
Pesticides
Aluminum utensil

30
Q

Heat wave nephropathy in India is known as

A

UDDANAM

31
Q

Primary Vesicoureteric reflux occurs in

A

Boys during antenatal pd and is of grade 4-5

32
Q

Grading of VUR

A

1 reflux to ureter

2 reflux to ureter and pelvicalyceal sys no dilatation

3mild to moderate dilatation no blunting of fornices

4severe dilatation blunting of fornices Papillary impression intact

5 Papillary impression lost

33
Q

Diagnosis of congenital VUR

A

Antenatal usg - fetal renal pelvis >5mm

34
Q

Patho of congenital VUR

A

Retrograde flow of urine from bladder to kidney

Shortening of intravesical submucosal length of ureter

35
Q

When to suspect VUR

A

Hydroureteronephrosis in mother
Vur in sibling
Uti in less than 7 yr child

36
Q

Most common cause of CKD

Rate of fall of gfr /yr

A

Diabetic NEPHROPATHY

8-10ml/mt /yr

37
Q

Grading of ckd is done on the basis of

A 
GFR
Grade 1 to 5 
GFR 90 to 15 ml/ mt 
Albumin secretion
Albumin creatine ratio
A1 <30mg /g 
A2 30-300 mg/g
A3 >300mg/g
38
Q

Mechanism of damage in ckd

A

When more than 50% nephrons are lost kidney independently progresses towards ckd

39
Q

Most important risk factor for kidney disease progression

A

Proteinuria

40
Q

Nephron loss leads to glomerular capillary hypertension what are sequlae of this

A

Mechanical stretching leads to mesangial endothelial podocyte cell proliferation and sclerosis

Protein accumulation in Podocyte leads to ang 2 release and gene activation tgf beta release
Foot process effacement

Glomerular permeability to protein increase

41
Q

Strongest morphological predictor of ckd progression

A

IF

TA

42
Q

Problem ass with ckd

A

Anemia
CV manifestation
Bone mineral changes
Others

43
Q

Substance which largely depend on gfr for excretion

Inversely related

A

Urea creatinine

44
Q

Substance which do not show change in plasma conc with renal failure because rate of excretion per surviving nephron increase

A

Sodium

45
Q

How to define anemia in ckd

A

Acc to KDIGO

Hb less than 13 male &12 female in ckd pt is anemia

46
Q

Erythopoietin independent phases in erythropoiesis

A

Pleuripotent stem cell to burst forming unit erythroid

47
Q

Erythopoietin dependant phases in erythropoiesis

A

BFU -E to CFU-E first step

CFU-E to erythroblast to reticulocyte

48
Q

Iron dependant phases of erythropoiesis

A

Erythroblast to erythrocyte

49
Q

When to start erythopoietin simulating agents in ckd pt

A

Hb less than 10

Target hb is 11-12gm/dl

50
Q

Indication for iron therapy in ckd

A

Percentage saturation of transferrin less than 30 %

Sr ferritin less than 500ng/ml

51
Q

Iron is given through which route amd composition

A

I/V iron - fe sucrose, ferric carboxymaltose, iron isomaltose

52
Q

Erythopoietin simulating agents are given by

Name first and second gen esa

A

Subcutaneous or intravenous
First gen

Epoietin alpha

Second gen

Darbepoietin alpha
CERA (continuous erythroid receptor activator )

53
Q

When do we say pt is resistant to esa because hb levels are not improving

A

Even after 300 unit /kg/wk ESA THERAPY

HB fails to improve it is resistance

54
Q

Major causes of resistance to ESA THERAPY

A

Iron deficiency
Infection
Underdialysis
Inflammation

55
Q

When do we treat anemia in ckd by epo mimetic as there are anti epo antibodies in blood

A

Epo mimetic- peginesatide

Pure red cell aplasia is ass with anti epo antibodies

56
Q

Complications of epo therapy

A

Stroke
HTN
Thrombosis
Malignancy

57
Q

Classification of mineral bone ds in ckd

A

High bone turnover ds -Osteitis fibrosa cystica 90%
Low bone turnover ds-Adynamic bone disease 10%
Miscellaneous
Osteomalacia abnormal mineralization
Osteoporosis decrease bone density

58
Q

Major cause of high bone turnover ds

A

Secondary hyperparathyroidism

Gfr less than 50-70

59
Q

Role of fgf in mineral bone ds as well as cardiovascular manifestation in ckd

A

As gfr decrease in ckd phosphorus level in blood increase but this is prevented by FGF 23

It also inhibits 1alpha hydroxylase which converts 25(OH) D3 to 1,25 (OH) D3 causing decrease calcium and phosphorus absorption from git

60
Q

Receptor for FGF 23

A

Klotho receptor

61
Q

Features of ckd pt with secondary hyperparathyroidism

A

Decrease serum calcium due to abnormal mineralization
Decrease calcitriol due to FGF
Increase klotho resistance leading to increase phosphorus level

62
Q 
Formation of woven bone
Medial calcification
Easy fracture, BONE PAIN 
Increase PTH PHOSPHORUS 
DECREASE SR CALCIUM AND CALCITRIOL
A

Osteitis fibrosa cystica -high bone turnover ds

63
Q

Low turnover ds is characterized by

A

PTH low due to increase calcium from exogenous an d calcium dialysate

Vit D sr calcium phosphate increased

64
Q

Widespread medial calcification is seen in

A

Adynamic bone disease
Medial calcification means tunica media calcification
Leads to decrease arterial distension and LVH

65
Q

How to manage low bone turnover ds

A

Stop ca and vit d
Zero calcium dialysate
Vit K2 analogue

66
Q

Mgt of high bone turnover ds

A

If Sr calcium low phosphorus high
Dietary restrictions on phosphorus
Phosphate binders preferred

If sr calcium high and phosphorus high
Seen in 3 degree hyper PTH
Cinacalet -calcium sensing receptor agonist helps pth to sense calcium and inhibit pth

67
Q

Names of phosphate binders

A 
Lanthanum 
Sevelamer carbonate 
Sucroferric oxyhydoxide 
Niacin 
Tenapanor 
Ferric citrate
68
Q

Leading cause of mortality in ckd

A

Cardiac cause - 50% esrd pt die from cvs manifestation

Medicine (11 decks)

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