Day 9 5/26/15

Question 1

Definition of Chronic Kidney Disease

Answer 1

• a permanent reduction in glomerular filtration rate (GFR).

- Hallmark of CKD is loss of flexibility in responding to changes in external balance of solutes and water

Question 2

CKD Staging System

Answer 2

CKD Stage

1: ≥90 and evidence of kidney damage
Nl GFR with kidney damage

2: 60-89 and evidence of kidney damage
Nl GFR with kidney damage

3: 30-59
Mild CKD

4: 15-29
Moderate CKD

5:

Question 3

Most Common Causes of CKD

Answer 3

-Diabetic nephropathy-most common
 -Hypertensive nephrosclerosis & Renal vascular disease
-Glomerulonephritis
-Polycystic kidney disease
-Interstitial nephritis
-Obstruction

Question 4

Why is CKD Silent?

3 Hypotheses

Answer 4

• Intact Nephron Hypothesis: Nephrons functioning in diseased kidneys maintain glomerulotubular balance comparable to all other nephrons. That is, filtration and net excretion are coordinated.
• The Magnification Phenomenon: Although nephrons in diseased kidneys function homogeneously, they alter their handling of given solutes as needed to maintain external balance of that solute if possible. That is, they magnify their excretion of a given solute.
• Individual Solute Control Systems: Each solute appears to have a specific control system that is geared to maintain external balance in CKD. Each solute system has individual tubular handling and hormonal influences.

Question 5

Uremia

Answer 5

Systemic intoxication

• Retained metabolic products: Urea or other solutes that accumulate in CKD
• Overproduction of counter-regulatory hormones: PTH
• Underproduction of kidney hormones: Erythropoietin, 1,25 Vitamin D

Question 6

Systemic Problems Related to CKD

Answer 6

Hypertension
– Occurs in 90+% of patients with CKD
– Expansion of extracellular fluid volume
– Increased activity of the renin-angiotensin system
– Dysfunction of autonomic nervous system

Bone and mineral disorders
– Fractures
– Bone pain

Question 7

Most Important Factor for Delaying Progression of Kidney Disease

Answer 7

• blood pressure control
• combo of 3 or more drugs usually needed
• no therapy can completely stop progression