Diseases in Nephrology (AKI and CKD) Flashcards
Associated with multiple myeloma
Renal amyloidosis
MOST common form of AKI
Prerenal azotemia
MOST common cause of CKD
DM
Patchy necrosis, PCT and LH affected, relatively short length of tubules affected
Ischemic type ATN (e.g. in hypovolemia)
Extensive necrosis, PCT and DT affected, relatively longer lengths of tubules affected
Toxic type ATN (e.g. in use of aminoglycosides, radio-contrast dyes)
Acts as an essential mediator of increased intraglomerular capillary pressure by selectively increasing efferent arteriolar vasoconstriction relative to afferent arteriolar tone
Angiotensin II
MAJOR pathway for reducing excess total body K+
Renal excretion
THREE broad categories of AKI
Prerenal azotemia
Intrinsic renal disease
Postrenal obstruction
MOST common clinical conditions associated with prerenal azotemia
Hypovolemia
Decreased cardiac output
Medications that interfere with renal autoregulatory responses such as NSAIDs and inhibitors of angiotensin II
MOST common causes of intrinsic AKI
Sepsis
Ischemia
Nephrotoxins
Usual clinical course of contrast induced nephropathy
A rise in SCr beginning 24-48 hours following exposure
Peaking within 3-5 days
Resolving within 1 week
MOST common protein in urine and produced in the thick ascending limb of the loop of Henle
Uromodulin/Tamm-Horsfall Protein
Large kidneys observed in patients with CKD suggest the following:
Diabetic nephropathy
HIV-associated nephropathy
Infiltrative diseases
Occasionally acute interstitial nephritis
Provide DEFINITIVE diagnostic and prognostic information about AKIs and CKDs
Kidney biopsy
Hallmark of AKI
Buildup of nitrogenous waste products, manifested as an elevated BUN concentration (azotemia)
Definitive treatment of the hepatorenal syndrome
Liver transplantation
Continuous Renal Replacement Therapy is often PREFERRED in patients with
Severe hemodynamic instability
Cerebral edema
Significant volume overload
Chronic renal failure typically corresponds to:
CKD stages 3-5
End-stage renal diseases refers to
Stage 5 CKD (
Protein-creatining ratio
Signifies chronic renal damage - persistence in the urine of:
>17 mg of albuming/g creatinin in males
2517 mg of albuming/g creatinin in adult females
Good SCREENING test for eraly detection of renal disease
Microalbuminuria (esp. in DM)
Thiazide diuretics have limited ability in
Stages 3-5 CKD
Alkali supplementation may be recommended to slow catabolism and CKD progression when
Serum bicarbonate concentration falls below 20-23 mmol/L
Water restriction is indicated only if there is
Hyponatremia and volume overload
OPTIMAL management of secondary hyperparathyroidism and osteitis fibrosa
Preventation
Major side effect of calcium-based phosphate binders
Total-body calcium accumulation and hyper calcemia
LEADING cause of morbidity and mortality in patients at every stage of CKD
Cardiovascular disease
Major risk factor for ischemic cardiovascular disease
Presence of any stage of CKD
One of the most common complications of CKD
Hypertension
Among the strongest risk factors for cardiovascular morbidity and mortality in CKD
Left ventricular hypertrophy and dilated cardiomyopathy
ABSENCE of hypertension may signify the presence of
Self-wasting form of renal disease
Effect of antihypertensive therapy
Volume depletion
May signify poor left ventricular function
CKD pateints with DM or proteinuria >1g per 24 h blood pressure should be reduced to
125/75 mmHg (salt restriction should be the first line of therapy
Normocytic, normochromic anemia is
Observed as early as stage 3 CKD
Almost universal by stage 4
PRIMARY cause of anemia
Insufficient production of erythropoietin by the diseases kidneys
ESSENTIAL to ensure an optimal response to EPO in patients with CKD
Iron supplementation
Target Hgb concentration in CKD
100-115 g/L
Peripheral neuropathy usually becomes clinically evident after the patient reaches
Stage 4 CKD
Common in advanced CKD and is often an indication for initiation of dialysis
Protein energy malnutrition (a consequence of low caloric and protein intake)
Assessment for protein-energy malnutrition should begin at
Stage 3 CKD
Metformin is contraindicated when the
GFR is less than half of normal
FIRST line of management of pruritus in CKD
Rule out unrelated skin disorders, such as scabies and treatment of hyperphosphatemia
Indication for therapy with ACE inhibitors or ARBs
Protein excretion >300 mg (especially in DM nephropathy)
MOST important initial diagnostic step in the evaluation of a patient presented with elevated serum creatinine is
To distinguish newly diagnosed CKD from acute or subacute renal failure
Renal failure in glomerulonephritis BEST correlates histologically with
Appearance of tubulointestinal nephritis rather than with with the type of inciting glomerular injury
