Course Intro/ Epidemiology of Kidney Disease

Question 1

2. Define the CKD stages.

Answer 1

I  eGFR >90 damage with normal GFR
II eGFR 60-89 damage with mild GFR decrease
III eGFR 30-59 moderate GFR decrease
IV eGFR 15-29 severe GFR decrease
V eGFR <15 Failure

(units mL/min/1.73m3)

Question 2

3. Recognize the prevalence of CKD.

Answer 2

1 out of 9 people in the US are coping with kidney disease, a disease associated with a high burden of mortality and cost

1% of outpatient visits and 7.2% of hospital patients suffer from kidney disease

prevalence of dialysis is increasing

Question 3

3. List the primary causes of CKD.

Answer 3

2 most common causes are diabetes (44%) and hypertension (28%)

essential HTN: excess salt, abnormal arteries, increased blood volume, genetic disorder and stressful life

secondary causes: co-morbidities, medication, drugs, pregnancy, hormonal therapy

Question 4

3. Explain why there is an Epidemic of CKD.

Answer 4

diabetes and associated obesity continue to be a growing epidemic in the US with 44% of ESRD associated with DM

Question 5

4. Recognize CKD as a major risk factor for cardiovascular disease. (Why is it a major risk factor?)

Answer 5

CKD can cause HTN (as well as the converse)

when CKD is the cause of HTN, it puts patients at higher risk of CVD

it is often difficult to determine which began first CKD or HTN

Question 6

5. Describe the association of acute kidney injury and CKD.

Answer 6

est. 40% of patients with AKI(acute kidney injury) will end up with CKD

if patients have CKD, they are 10x more likely to have AKI

risk factors that modify the relationship include age, race/ethnicity, genetics, HTN, DM and metabolic syndromes

disease can be modified by severity of AKI, stage of CKD, number of episodes and duration of AKI

Question 7

Describe the broad categories of AKI causes and an example of each.

Answer 7

pre-renal (60%) volume depletion or renal vascular disease

intrarenal (30%): glomerular disease (ANCA or infection ie.), vascular (ie. NSAIDs or HUS) and tubulointerstitial (ATN, AIN or infection)

post renal (10%): obstruction (ureters, bladder, urethra)

Question 8

Differentiate between nephrotic and nephritic glomerular disease.

Answer 8

nephrotic: proteinuria >3g, edema, decreased albumin and increased cholesterol
nephritic: acute rise in creatinine, hematuria, lower level of proteinuria

Question 9

Define GFR.

Answer 9

amount of blood filtered by the nephron per unit time

Question 10

Contrast measured and estimated GFR.

Answer 10

measured is obtained by using IV injection of inulin or like compound and measuring serially the content of the blood (not efficient in clinic)

estimated GFR is used in clinical practice and is based on serum creatinine in the context of clinical factors (age, gender, race, muscle has, dietary protein)

Question 11

What are the general ways that kidney disease can be treated

Answer 11

hemodialysis (time consuming)
peritoneal dialysis (clean fluid in peritoneum which by diffusion can clean out toxins of blood)
kidney transplant (do not take out old kidney, new kidney is placed in pelvis)

Question 12

What factors signal a worse prognosis for those with CKD.

Answer 12

age (older)

transplant has a better prognosis than dialysis