Clinical Impact Of Ckd

Question 1

What is the functional unit of kidneys

Answer 1

Nephrons

Question 2

How can PCt absorb a lot of water and small molecules like glucose

Answer 2

Brush border

Question 3

What is descending permeable to

Answer 3

WTer only

Question 4

What happens in ascending limb

Answer 4

Na/k/Cl cotransproter for na reabsorption and dilution of urine

Question 5

What hormone is released during low bp/flow to kidneys

Answer 5

Renin

Question 6

What does this do

Answer 6

Angiotensin 1 conversion to 2

Production of aldosterone (enac na reuptake ar collecting duct)

Question 7

Which cells are in late dct and collecting duct

Answer 7

Intercalating for HCO/h balance

Principal for removal of k and regulated na and water reabsorption

Question 8

What makes the 3 glomerular filtration barriers in the renal corpuscle

Answer 8

Fenestrated wndothelial
Glomerular basement membrane
Podocytes with filtration slits

Question 9

What do endothelial cells have which causes electrostatic repulsion as negative charge with protein

Answer 9

Glycocalyx layer with sialoproteins like podocalyxin

Question 10

What makes gbm negative too

Answer 10

Heparan sulphate pgs (it is an ecm)

Question 11

What do podocytes have that’s negative

Answer 11

Sialogps also eg podocalyxin

Question 12

How many A is max size for filtration

Answer 12

30

So albumin and large proteins and rbc not filtered

Question 13

what is the filtration pressure calculation

Answer 13

Fp = capillary pressure - (colloid osmotic from plasma protein + bc fluid pressure)

Question 14

What needs to happen to increase filtration pressure

Answer 14

Vasoconstriction of efferent eg via angiotensin

Question 15

What is used to measure kidney function

Answer 15

GFR

Vol cleared/unit time/1.73m(sa)

Question 16

Why isn’t urine output a determinant of kidney function

Answer 16

Some will have same output

Question 17

Why is creatinine perfect to be used to measure GFR

Answer 17

Freely filtered and not reabsorbed

Question 18

How is it produced

Answer 18

Creatine from liver stored in muscle gets degraded to creatinine

Question 19

Why is this not sensitive at higher gfrs (ie can’t detect early stages of GFR loss)

Answer 19

Because signchanges in Cr plasma only occur at v low GFR

It is an exponential relationship

So at higher GFR like 50 the cr in plasma similar to 90

Question 20

What is the normal GFR

Answer 20

90+ ml

Question 21

What does GFR levels not account for

Answer 21

Cr levels in people

Muscle mass difference in gender, elderly, amputees, liver disease

Question 22

Why could women be over diagnosed or men misdiagnosed as normal

Answer 22

Low cr to begin with

High and limited change in men

Question 23

What is used to estimate GFR from Cr levels of blood and why not urine

Answer 23

Urine would need 24 hour collection

Can use formulas which deteeemine likely GFR based on serum cr and ethnicity, gender and age

Question 24

What 3 things can be done to quantify proteinuria / hematuria

Answer 24

Dipstick test

Urine collection/ urinalysis for 24 hours

Albumin/Cr ratio from spot urine sample

Question 25

Why does nice recommend the ratio

Answer 25

It accounts for differences in hydration level. As both decrease in conc as hydration goes up the cr allows adjustment to hydration levels (Conc would be more if less hydrated)

Question 26

What mg/mmol is normal of albumin

Answer 26

3mg or below

Question 27

How long do you need to have dysfunction according to nkf-kdqoi fuidelines

Answer 27

3 months

Question 28

What does GFR need to be reduced to

Answer 28

60 or below

Question 29

What does g1 to g5 mean

Answer 29

G1 is relatively normal GFR but some proteinuria so early stage of ckd G5 is below 15mls GFR so is kidney failure

Question 30

What does A1 to A3 mean

Answer 30

A1 is normal albumiurea but a3 is over 30mg/mmol

Question 31

What is the limitations of these guidelines

Answer 31

Use an estimated GFR based on formulas like mdrd which could misdiagnose based on age or gender etc

Question 32

Is ckd common in uk

Answer 32

Yes around 4 million people

Question 33

What is the likely demographic

Answer 33

Over 70s, women

Question 34

What are common comorbidities with ckd especially as you decrease GFR down further

Answer 34

Hypertension, cvd , diabetes

Question 35

Give some reasons why prevalence is increasing

Answer 35

More illnesses like diabetes II or hypertension More ethnically diverse with Africans having more ckd risk

Question 36

Why can hypocalcemia from kidney disease cause secondary osteodystrophy

Answer 36

Vit d not activated by kidneys so can’t absorb calcium from gut The parathyroid tries to compensate by removing calcium from bones

Question 37

Why is pulmonary oedema / edema in general common in ckd

Answer 37

Water retention

Question 38

What is link between anorexia and urea

Answer 38

Uraemia in ckd can cause poor appetite

Question 39

Which hormone from kidney is reduced in ckd causing iron deficiency and anemia

Answer 39

EPO

Question 40

What other symptoms can uraemia cause

Answer 40

Fatigue, itchiness, nausea , pericarditis

Question 41

What is the impact on mortality in lower egfr

Answer 41

Increased risk at eg g4

Question 42

What else is increased risk as ckd progressives

Answer 42

Cv events and hospitalisation

Question 43

Which non fatal events can microalbuminurea cause

Answer 43

Pulmonary edema and ventricular arrhythmia

Question 44

What increased risk of death after myocardial infarction

Answer 44

Microalbuminuria