Clinical II: Chronic Kidney Injury

Question 1

Name the staging process involved with Chronic Kidney disease (CKD)

Answer 1

Stage I: normal GFR + known kidney trauma/damage >90 ml/min
Stage II: 60-89 (mild)
Stage III: 30-59 (moderate)
Stage IV: 15-29 (severe)
Stage V:

Question 2

What are the most common causes of CKD?

Answer 2

• diabetic nephropathy

* hypertensive nephropathy/benign nephrosclerosis/hypertensive nephrosclerosis

Question 3

CKD is an independent risk factor for developing which illnesses?

Answer 3

Cardiovascular disease: ACS, stroke, DVT

*Most patients die from these illnesses before dying from kidney disease

Question 4

Mechanism of disease: diabetic nephropathy

Answer 4

angiopathy of small vessels affects the capillaries of glomerulus > over time will lead to scarring/glomerulosclerosis > destruction of glomeruli and loss of function = leads to kidney failure

Question 5

Mechanism of disease: hypertensive nephropathy

Answer 5

caused by hyaline arteriolosclerosis = pink deposits that leads to ischemia = tubular and glomerular damage

Question 6

List the less common causes of CKD

Answer 6

• Glomerulonephritis: IgA, post infectious, membranoproliferative, rapidly progressing GN (RPGN)
• Lupus nephritis
• Atheroembolic disease
• Nephrotic syndromes: MCD, glomerulosclerosis, membranous, amyloidosis

Question 7

Glo-nephritis: IgA

Answer 7

URI leads to production of IgA > excess IgA deposit in the glomeruli = dysmorphic RBCs and AKI

Onset: 1-2 days after infection
Associated with HIV

Question 8

Glo-nephritis: post-infectious

Answer 8

occurs after streptococcal infection
IC complexes lodge in the glomeruli BM > complement activation > destruction kidney

onset: 2-4 weeks after infection
findings: high ASO titer + low complement

Question 9

Glo-nephritis: membranoproliferative (MPGN)

Answer 9

children and young adults

deposits of IgG:complement (C3) in the mesangium

Question 10

Glo-nephritis: lupus

Answer 10

Different stages yet non-chronological

symptoms: HTN, hematuria, CKD, thrombophilia

Question 11

Glo-nephritis: Rapid progressive (RPGN)

Answer 11

• decrease in GFR
• three types
• crescents

Question 12

Nephrotic: Minimal Change Disease

Answer 12

• children
• treatable with steroids**
• proteinuria caused by damage to foot processes

Question 13

Nephrotic: glomerulosclerosis

Answer 13

• most common cause of nephrotic syndrome in adults

- associated with: HIV, heroin use, familial forms

Question 14

Nephrotic: membranous nephropathy

Answer 14

• affects Caucasians
• causes: SLE, infection, drugs, tumor
• treat: immunosuppressive therapy; difficult to treat

Question 15

Nephrotic: amyloidosis

Answer 15

• amyloid deposits in tissues/organs > damage
• many different types
• associated with CKD, heart disease, MULTIPLE MYELOMA
• symptoms: cardiac: LVH/HF, enlargement of tongue, nephropathy and carpel tunnel

Question 16

Atheroembolic disease

Answer 16

weeks to mths (vs ATN = immediate response)

• cholesterol released from plaque
• symptoms: fever, malaise, renal failure, rash (lacelike appearance: livedo reticularis)

Question 17

What is the treatment for stages II & III?

Answer 17

• conservative renal protection
• exercise
• control of other morbidities
• give ARBs or AceInh = renoprotective effects

Question 18

What is the treatment for stage IV?

Answer 18

• HTN control
• proteinuria reduction: to slow progression
• low protein diet
• give vit D to treat metabolic bone disease caused by -excess phosphorous
• treat anemia: give EPO
• dialysis

Question 19

Describe hemodialysis

Answer 19

diffusion of molecules down electrochemical gradient

• urea : into dialysis fluid
• bicarb: into blood

diffusion depends on [solute], MW, and protein binding status