L12-Chronic Kidney Disease Flashcards
What is chronic kidney disease and why is it a problem?
Chronic kidney disease is a profound decrease in GFR. This is a problem as it can lead to a build up of nitrogenous waste products. Can also cause metabolic acidosis.
What are the two main types of kidney disease?
Chronic (progressive nephron loss)
Acute (acute nephron loss)
Why is eGFR better than serum creatine for measuring kidney function?
Serum creatine varies greatly depending on your age, gender and ethnicity
What is the result of kidney disease on sodium?
Loss of nephrons reduces the ability to excrete sodium and this can lead to confusion and fits as sodium is out of the normal neurological range.
What is the result of kidney disease on Potassium?
The kidney has an enormous functional reserve for excreting potassium as it is so bad for you. However if GFR falls below 10ml/min then hyperkalcaemia can develop. this can cause cardiac arrhythmias and other problems.
How is a metabolic acidosis of the kidneys compensated for by the lungs?
The bicarbonate buffer system will buffer the excess H+ ions and cause more H2O and CO2 to be produced. This will result in an increased ventilation rate that will get rid of the CO2 excess
What 3 hormones does the kidney produce and what are they for?
Vitamin D-calcium homestasis (converted to active form in kidney)
Erythropoeitin-haemoglobin production
Renin-control of blood pressure
What are the different stages of chronic kidney disease?
Stage 1 - Kidney damage with GFR normal Stage 2 - Kidney damage with mild decrease in GFR Stage 3 - Moderate decrease in GFR Stage 4 - Severe decrease in GFR Stage 5 - Kidney failure (GFR<15)
What are some common causes of chronic kidney disease?
Diabetes mellitus
Hypertension
Ischaemia
What percentage of type 1 diabetics will develop renal disease?
40% with a similar risk in type 2 diabetes patients
What is the pathological mechanism behind diabetics getting kidney disease?
Thickening of the basement membrane
mesangial expansion (hyperglycaemia stimulates increased matrix production)
glomerulosclerosis
What is the treatment for diabetic nephropathy?
good glycaemic control
ACE inhibition
hypertension control
treat hyperlipidaemia
What is membranous nephropathy?
It is a progressive thickening of the basement membrane of the glomerulus
What are the causes of membranous nephropathy?
60% are idiopathic
Infection
Drugs
Auto-immune
