Kidney Disease Flashcards
What is pre-renal kidney disease?
Its inadequate flow of blood to the kidney, where its not adequately filtered. This is due to decrease in blood volume. NSAIDs and ARBs, ACE-Is cause it.
What is intra-renal disease and its components?
Based upon the component of the kidney that is primarily affected.
Tubular: caused by ischemia/nephrotoxicity. Blood flow is usually diverted away from the cortex toward the medulla.
Glomerulonephritis: inflammation of the glomeruli (infections, immune diseases and hypertension cause this)
Interstitial: acute interstitial nephritis.
Vascular: involves the renal arteries or veins.
What is post-renal disease?
Results from obstruction of urine outflow from the kidneys. Bilateral obstruction: prostatic hyoerplasia
Unilateral obstruction: Nephrolithiasis (kidney stones) both ureters must be blocked.
What is hyperfiltration and what causes it?
Increased GFR, obesity and diabetes causing it. Its also common in consuming high protein meals. This increases glomerular pressure causing increased filtration of individual nephrons leading to damage and loss.
What is glomerulosclerosis?
Scarring of the glomeruli. Causes problems with the filtering process of the kidneys. Proteins leak into the urine.
What are some risk factors of chronic kidney disease?
Diabetes, hypertension, albuminuria, smoking (nicotine reduces GFR and increases urinary albumin excretion) and obesity.
What about Na+ balance and volume status?
Excess Na+ and water. Excessive Na+ ingestion causes fluid retention and causes heart failure, hypertension, peripheral edema and weight gain. Limit sodium to 2g/d or less and restict fluid intake.
How does metabolic acidosis occur in CKD?
Impaired capacity of the kidneys to excrete the daily acid load as ammonium and titratable acid. Causes acid retention and metabolic acidosis. Thus affects bone mineral content and promotes skeletal muscle catabolism.
How are minerals and bone affected in CKD?
Diminished absorption of Ca2+ from the gut. Overproduction of PTH. Disordered vitamin D metabolism. Retention of phosphorus. Chronic metabolic acidosis.
What are cardiovascular and pulmonary abnormalities?
Volume and salt overload can cause failure and pulmonary edema. And hypertension. Hyperreninemia due to decreased renal perfusion, which elevates systemic blood pressure. Uremic toxins can cause pericarditis.
What are some hematologic abnormalities in CKD?
Abnormalities in RBC count, WBC function and clotting factors. Anemia due to decreased production of erythropoietin causing decreased erythropoiesis. The bone marrow can be affected by uremic toxins and elevated blood PTH can cause bone marrow fibrosis. Decreased clotting leads to hemorrhage.
What are endocrine and metabolic abnormalities?
Low estrogen levels. Amenorrhea and decreased fertility. Pregnancies arent finished.
Low testosterone levels, impotence. Insulin degradation decreases.
What is rhabdomyolysis?
Occurs when skeletal muscle fibers break down and release their contents into the bloodstream. Creatine kinase rises when muscle is damaged. Myoglobin contains iron and transports and stores O2 in myocytes. Electrolytes indicate muscle damage. Myoglobin cytotoxicity affects the kidney by production of reactive oxygen species. Induced by statins and alcohol.
What is chronic interstitial nephritis?
Causes fibrosis and renal scarring. Due to chronic use of paracetamol, aspirin, diuretics and lithium.
What dose adjustment is needed for antihypertensives?
Thiazide diuretics are not recommended if the creatinine level is higher than 2.5 mg per dL. Loop diuretics are used. ACE-Is and ARBs cause efferent arteriolar dilation.
Beta-blockers need dose adjustments. Propranolol and metoprolol dont need liver adjustments. CCBs dont need dose adjustments.
