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REN > L11: Chronic Kidney Disease > Flashcards

L11: Chronic Kidney Disease Flashcards

1
Q

What are the 3 main functions of the kidney

A

Homeostasis
Endocrine
Excretion of drugs

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2
Q

What happens to the creatinine concentration when kidney function gets worse

A

Creatinine increases

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3
Q

What happens to the creatinine levels when kidney function improves

A

Kidney function gets better

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4
Q

Why is measuring creatinine levels alone not reliable

A

When kidney function reduced from 100% to 50% creatinine levels can show to be normal when in-fact kidney function is declining

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5
Q

Instead of measuring creatinine levels what do we measure instead

A

Estimated GFR

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6
Q

What does the estimated GFR consider

A

Age
Ethnicity
Creatinine

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7
Q

What is the normal range for estimated GFR

A

Above 90

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8
Q

What is the definition of chronic kidney disease

A

Estimated GFR less than 60ml/min/1.73m2

Or kidney damage that has been present less than 3 months

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9
Q

Is chronic kidney disease reversible

A

No it is irreversible

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10
Q

How many stages of chronic kidney disease is there

A

5

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11
Q

Which stage is the worst chronic kidney disease

A

Stage 5

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12
Q

What is stage 5 chronic kidney disease also known as

A

Renal failure

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13
Q

What happens to the estimated GFR as stages of chronic kidney disease increase

A

Estimated GFR decreases

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14
Q

In renal failure what type of treatment does the patient require

A

Dialysis: peritoneal or haemodialysis

Transplantation

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15
Q

What are the categories of causes of developing chronic kidney disease

A 
Systemic disease
Immune mediated disease
Infectious disease 
Genetic 
Arterial disease 
Obstruction
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16
Q

What does systemic disease include

A

Hypertension

Diabetes

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17
Q

What doe immune mediated disease involve

A

Membranous nephropathy

IGA nephropathy

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18
Q

What does infectious disease involve

A

HIV
HBV
TB
HCV

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19
Q

What does genetic disease involve

A

Polycystic disease

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20
Q

What does arterial disease involve

A

Artheroscelorisis

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21
Q

What does obstruction involve

A

Stones
Tumours
Fibrosis

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22
Q

When patient have diabetes what pathological changes can occur in the kidney to cause chronic kidney disease

A

Basement membrane of glomerulus thickens

Mesangial cells multiply

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23
Q

When obstruction occur

A

Stones
Tumours : inside or outside
Fibrosis
Benign prostate

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24
Q

What can the failure of fluid homeostasis lead to

A

Oedema

Inability to concentrate urine

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25
Q

What is the treatment for fluid overload

A

Diuretics
Restrict salt
Restrict fluid intake
Dialysis or transplant (if everything fails)

26
Q

What happens to the secretion of sodium in CKD

A

Decreases

27
Q

What does reduction in salt secretion lead to

A

Hypertension

Fluid overload

28
Q

Why do we get hyponatraemia

A

Water dilutes the salt

29
Q

What is the treatment of hyponatraemia

A

Reduced salt intake

Dialysis or transplant

30
Q

What happens to potassium secretion in CKD

A

Decreases

31
Q

What does a build up of potassium lead to

A

Hyperkalaemia

32
Q

What can hyperkalaemia lead to

A

Cardiac arrhythmia

33
Q

What is the treatment for hyperkalaemia

A

Restrict potassium in diet

Dialysis or transplant (If it fails)

34
Q

What happens to hydrogen secretion in CKD

A

Decreases

35
Q

What does reduced secretion in CKD lead to

A

Metabolic acidosis

36
Q

How is metabolic acidosis compensated

A

Hyperventilation

37
Q

What is the treatment for metabolic acidosis

A

Reduce hydrogren ingestion
Sodium bicarbonate
Dialysis or transplant (if everything else fails)

38
Q

Which 3 hormones are produced by the kidney

A

EPO
Renin
Active vitamin D

39
Q

What is the role of active vitamin D

A

Increase calcium and phosphate reabsorption from the gut

40
Q

Which organ in the body detect low calcium

A

Parathyroid gland

41
Q

What hormone does the parathyroid gland secrete when it detects low calcium

A

PTH

42
Q

What does PTH act on

A

Kidney

Bone

43
Q

What happens to the kidney

A

Converts inactive vitamin d to active vitamin D

44
Q

What does active vitamin D do to bring levels of calcium back up

A

Increase the reabsorption of calcium and phosphate from the gut

45
Q

What happens to the level of PTH when calcium levels rise

A

PTH is switched off via a negative feedback

46
Q

When the kidney doesn’t work i.e we do not get vitamin d to absorb calcium from the gut what happens to the PTH levels

A

Rise

47
Q

What does high levels of PTH lead to

A

Hyperparathyroidism

48
Q

What does high levels of PTH cause the bone to do

A

Turn over and release calcium

49
Q

What is the treatment for bone disease and calcification

A 
Give vitamin d analogues 
Phosphate binders
Calcium supplement 
Phosphate restriction 
Remove parathyroid gland
50
Q

What is EPO involved in

A

The production of RBC in the bone marrow

51
Q

In which condition is EPO released from the kidney

A

Hypoxia

52
Q

What is the treatment for renal anaemia

A

Give EPO

53
Q

Does hypertension cause CKD

A

Yes

54
Q

Is hypertension also a consequence in CKD

A

Yes

55
Q

When can hypertension occur

A 
Sodium retention
Volume overload 
RAAS activation 
SNS activity 
Endothelial dysfunction
56
Q

What is the treatment for hypertension

A 
Decrease salt intake 
Decrease fluid intake 
Anti hypertensives 
Diuretics 
RAAS blockade drugs
57
Q

What is the treatment of uraemia

A

Dialysis or transplant

58
Q

Why do we not do protein restriction as a method of treatment for uraemia

A

Protein restriction can lead to malnutrition

59
Q

In CKD what can happen to drug excretion

A

Decrease

60
Q

What does a decrease in drug excretion lead to

A

Drugs accumulating and giving drug toxicity

61
Q

How can we prevent drug toxicity

A

Reduce the dose of the drug

REN (19 decks)

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