CKD - Uremia

Question 1

T/F. Accumulation of creatinine and urea can account for the all symptoms and signs that characterize the uremic syndrome in advanced renal failure

Answer 1

• False
• Accumulation of these two molecules themselves does not account for the many symptoms and signs that characterize the uremic syndrome in advanced renal failure
• Note:*
• Serum concentrations of urea and creatinine should be viewed as being readily measured, but very incomplete surrogate markers for retained toxins, and monitoring the levels of urea and creatinine in the patient with impaired kidney function represents a vast oversimplification of the uremic state

Question 2

T/F. The uremic syndrome involves more than renal excretory failure

Answer 2

• True
• A host of metabolic and endocrine functions normally performed by the kidneys is also impaired, and this results:
  
  • Anemia
  • Malnutrition
  • Abnormal metabolism of carbohydrates, fats, and proteins
  • Change in metabolism of PTH, FGF-23, insulin, glucagon, steroid hormones including vitamin D and sex hormones, and prolactin as a result of reduced excretion, decreased degradation, or abnormal regulation
  • Increased systemic inflammation

Question 3

CKD is associated with increased systemic inflammation usually supprted by what lab findings?

Answer 3

• Elevated levels of C-reactive protein are detected along with other acute-phase reactants
• Negative acute-phase reactants, such as albumin and fetuin, decline

Question 4

The inflammation associated with CKD is important in the ____ syndrome, which contributes in turn to the acceleration of ____ associated with advanced kidney disease

Answer 4

• Malnutrition-inflammation-atherosclerosis/ calcification
• Vascular disease and comorbidity

Question 5

The pathophysiology of the uremic syndrome can be divided into manifestations in three spheres of dysfunction:

Answer 5

1. those consequent to the accumulation of toxins that normally undergo renal excretion
2. those consequent to the loss of other kidney functions, such as fluid and electrolyte homeostasis and hormone regulation; and
3. progressive systemic inflammation and its vascular and nutritional consequences