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Clinical Med II > Exam 3 - CKD and Nephrotic Syndrome > Flashcards

Exam 3 - CKD and Nephrotic Syndrome Flashcards

1
Q

What are the leading causes of kidney failure?

A

Diabetes and HTN

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2
Q

Define CKD.

A

Decreased kidney function
OR
Kidney damage for 3 or more months

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3
Q

What GFR rate and urine albumin-to-creatinine ratio defines CKD?

A

GFR < 60

ACR > or equal to 30

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4
Q

What is the best index of overall kidney function?

A

GFR

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5
Q

What is the hallmark of progressive kidney disease?

A

Declining GFR

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6
Q

What is the pathogenesis of CKD?

A

Irreversible destruction of nephrons leads to compensatory hypertrophy and increased GFR of remaining nephrons, leading to compensatory hyperfiltration and overwork injury of these nephrons. This ultimately leads to glomerular sclerosis and interstitial fibrosis.

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7
Q

Who should be screening for CKD?

A

All individuals should be assess as part of routine health exams to determine risk.

Those who are at risk should be screened via ACR and serum Cr (eGFR).

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8
Q

The following symptoms are associated with what disorder?

  • Fatigue, malaise
  • Pruritis, easy bruisabiliy
  • Metallic taste
  • Dyspnea, percarditis
  • Seizures, encephalopathy/confusion
A

Uremic syndrome

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9
Q

What finding on renal ultrasound supports a diagnosis of CKD?

A

Small kidneys bilaterally (<9-10cm)

***normal or large can be seen as well such as in PKD

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10
Q

The production of what two hormones will be affected by progressive nephron and GFR loss?

A
  • Erythropoietin (EPO)

- Calcitriol

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11
Q

What is the goal of using an ACE-I or ABRs in patients with CKD?

A

Helpful in slowing the progression of proteinuric CKD by decreasing albuminuria

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12
Q

When can using an ACE-I/ARB be harmful in treating kidney disorder?

A
  • Caution in acute kidney injury as these meds decrease glomerular pressure, but in AKI you want to increase pressure to increase perfusion
  • Contraindicated in bilateral renal artery stenosis
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13
Q

What is the difference in target BP in CKD patients with proteinuria versus without?

A

With proteinuria - < 130/80

Without protienuria - < 140/90

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14
Q

As a PCP, what is a common indication to refer a patient to nephrology?

A

GFR < 30

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15
Q

What treatments does renal replacement therapy encompass and what patient is it indicated in?

A

Dialysis and kidney transplant

Indicated for patients with kidney failure/ESRD

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16
Q

What are some indications to initiate dialysis in CKD?

A
  • Uremic symptoms
  • Fluid overload unresponsive to diuresis
  • Refractory hyperkalemia, acidosis, and hyperphosphatemia
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17
Q

What are some acute complications of hemodialysis?

A
  • Hypotension (possibly took off too much fluid?)
  • N/V
  • Cramps
  • HA, chest pain
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18
Q

What are possible complications of peritoneal dialysis?

A
  • Peritonitis
  • Site infection
  • Poor dialysate drainage
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19
Q

What is the treatment of choice for ESRD?

A

Kidney transplant

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20
Q

What are three common underlying etiologies of chronic tubulointerstitial disease?

A
  • Obstructive uropathy
  • Reflex nephropathy
  • Analgesic nephropathy
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21
Q

What are general findings associated with Chronic Tubulointerstitial Disease?

A
  • Polyuria (inability to concentrate urine due to tubular damage)
  • Hyperkalemia (due to decreased GFR and tubules become aldosterone resistant)
  • UA is nonspecific with broad waxy casts
22
Q

What is the most useful test in detecting obstructive uropathy?

A

Ultrasound

23
Q

What symptoms can be present with obstructive uropathy?

A

Pain, change in urine output, HTN, hematuria, increase serum Cr

24
Q

What is Reflux Nephropathy?

A

Consequence of vesicoureteral reflux (VUR) or other urologic anomalies

Fibrosis of kidney occurs

25
Q

In what population is Reflux Nephropathy typically diagnosed?

A

Young children with a hx of recurrent UTIs

26
Q

What is Analgesic Nephropathy?

A

CKD caused by long-term consumption of analgesics, often when taken in combination medications (acetaminophen, NSAIDs)

27
Q

What population is Analgesic Nephropathy more common in?

A

Women using analgesics for low back pain, migraine headaches, or other chronic MSK pain

28
Q

What is Nephrotic Syndrome?

A

Non-inflammatory damage to the glomerular capillary wall (podocyte and GBM)

29
Q

What is the Nephrotic spectrum?

A

Comprised of diseases that present primarily with proteinuria and a bland urine sediment.

30
Q

Is the nephritic spectrum or nephrotic spectrum more associated with protienuria?

A

Nephrotic

31
Q

What are features that define Nephrotic Syndrome?

A

Proteinuria > 3.5, hypoalbuminemia, edema, hyperlipidemia

32
Q

The following signs and symptoms are associated with what syndrome?

  • Edema
  • Ascites
  • “Foamy urine” with oval fat bodies
  • Proteinuria > 3.5 g/day
  • Malaise
  • Dyspnea
A

Nephrotic Syndrome

33
Q

What are some complications of Nephrotic Syndrome?

A
  • Protein malnutrition (losing albumin)
  • Hypercoagulability (urinary loss of antithrombin, protein C)
  • Infection
  • Anemia
34
Q

What will be seen on urine microscopy in Nephrotic Syndrome?

A

Oval fat body

35
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal Change Disease (MCD)

36
Q

What is the typical clinical presentation of Minimal Change Disease?

A
  • Following URI or hypersensitivity reaction
  • Sudden onset
  • Edema and “puffy appearance”
37
Q

What is the 1st line treatment for Minimal Change Disease?

A

Prednisone

38
Q

Patient present with sudden onset of edema and a “puffy appearance” days after a URI. What do you suspect?

A

Minimal Change Disease (MCD)

39
Q

In what population is Membranous Nephropathy (MN) most common in?

A

White male over 40

40
Q

How does a patient with Membranous Nephropathy present?

A

Gradual development of nephrotic syndrome

41
Q

What are patients diagnosed with Membranous Nephropathy at a higher risk for?

A

Higher risk of hypercoagulable state (eg. renal vein thrombosis)

42
Q

What population has a higher risk of developing Focal Segmental Glomerulosclerosis (FSGS)?

A

African-American males

43
Q

What two causes are associated with secondary glomerular nephrotic diseases?

A
  • Diabetic Nephropathy

- Amyloidosis

44
Q

What is the most common cause of ESRD in the United States?

A

Diabetic Nephropathy

45
Q

What will seen on labs in a patient with Diabetic Nephropathy?

A

Albuminuria > 300 mg/d

46
Q

What is the treatment for Diabetic Nephropathy?

A
  • Strict glycemic and BP control
  • ACE-I/ARBs
  • Statin therapy
  • Dialysis/transplant when indicated
47
Q

What is the cause of Renal Amyloidosis?

A

Deposition of amyloid in the glomerulus

48
Q

What are some signs and symptoms of renal involvement in amyloidsis?

A
  • Proteinuria
  • Decreased GFR
  • Nephrotic syndrome
49
Q

What screening tests should be performed for Renal Amyloidosis?

A

SPEP and UPEP

50
Q

What is an early sign of Diabetic Nephropathy?

A

Albuminuria

51
Q

What will be seen on CT in a patient with analgesic nephropathy?

A

Renal papillary necrosis and calcification

Clinical Med II (17 decks)

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