Lect 2 Flashcards
what is CKD associated with?
abnormal kidney function and progressive decline in GFR
chronic renal failure corresponds with what CKD stages?
Stages 3-5
end-stage renal disease (ESRD)
final stage of CKD
accumulation of toxins, fluid, and electrolytes normally excreted by the kidney
results in uremic syndrome and pt will die w/o dialysis or kidney transplant
Stage 0
GFR >90 with risk factors fro CKD
Stage 1
GFR>90 w/ kidney damage (persistent proteinuria, abnormal urine sediment, abnormal blood chemistry, abnormal imaging studies)
Stage 2
GFR 60-89
Stage 3
GFR 30-59
Stage 4
GFR 15-29
Stage 5
GFR less than 15
consequences of glomerular hyperfiltration
Compression of endothelial cells → cannot really function anymore/ will be occluded → increase in capillary pressure and enlarged capillaries
histology of CKD
In chronic kidney disease, regular renal parenchyma is replaced by fibrotic tissue
Also have loss of tubules
risk factors for CKD
HTN, DM, autoimmunity (SLE!!), age, african ancestry, family history, previous episode of AKI, proteinuria, abnormal urinary sediment, structural abnormalities
what is the peak GFR?
120 mL/min
what is the mean decline in GFR?
declines 1 mL/year reaching a mean value of 70 mL/min at age 70 (mean GFR is lower in women than in men)
monitoring nephron injury
GFR, 24h urine collection (albuminuria), spot first-morning urine sample (protein to creatinine ratio)
monitoring nephron injury
GFR, 24h urine collection (albuminuria), spot first-morning urine sample (protein to creatinine ratio)
microalbuminuria
excretion of amount of albumin too small to detect by regular urine dipstick
good screening test for early detection of renal disease
stage 1 and 2 symptoms
• No sx in stage 1 and 2 related to dec GFR
○ b/c you still have enough parenchyma to compensate for the loss of GFR
○ But you will see the sx of the underlying disease that is causing the problem
stage 3 and 4 symptoms
have sx assoc with dec GFR
anemia w/ easy fatigability, decreased appetite with malnutrition, abnormalities in Ca, Na, K, H20, phos, and mineral-regulated hormones
abnormalities in acid-base homeostasis
stage 5
toxins accumulate
uremic syndrome
LEADING ETIOLOGIES OF CKD
- diabetic glomerular disease
- glomerulonephritis
- hypertensive nephropathy (elderly)
- autosomal dominant polycystic kidney disease
- other cystic and tubulointerstitial nephropathy
pathophys of uremia
accumulation of toxins
anemia, malnutrition, and abnormal metabolism of carbs, fats, and proteins
progressive systemic inflammation (elevated levels of C-reactive protein)
clinical abnormalities of uremia
leads to disturbances in the function of virtually every organ system
acid/base disturbances
metabolic acidosis= abnormally high level of acid and low level of bicarb from inability to excrete protons
fluid and electrolyte disturbances
hypovolemia, hyperkalemia (more often in DM, obstructive nephropathy, and sickle cell nephropathy), hypokalemia (rare)
what is the leading cause of morbidity and mortality in pts at every stage of CKD?
cardiovascular disease
cardiovascular abnormalities examples
ischemic CV disease, HTN, left ventricular hypertrophy, pericarditis, HF and pulmonary edema
hematologic abnormalities in CKD
normocytic, normochromic anemia (from insufficient erythropoietin)
abnormal hemostasis
prolonged bleeding time
thromboembolism in nephrotic syndrome (loss of anticoagulants)
uremic fetor
urine-like odor on the breath; derives from breakdown of urea to ammonia in saliva; assoc w/ unpleasant metallic taste
uremic fetor
urine-like odor on the breath; derives from breakdown of urea to ammonia in saliva; assoc w/ unpleasant metallic taste
bone manifestations of CKD
- high bone turnover w/ increased PTH levels (osteitis fibrosa cystica)
- low bone turnover w/ low-normal PTH levels (adynamic bone)
secondary hyperparathyroidism
when GFR falls below 60 mL/min
Declining GFR → reduced excretion of phos → retained phos stim increased PTH → decreased levles of ionized Ca from decreased calcitriol prod by failing kidney stim PTH prod
FGF-23
promotes renal phos excretion
excreted by osteocytes
increases early in course of CKD
** high levels of FGF-23 are also an independent risk factor for left ventricular hypertrophy and mortality in dialysis pts
osteomalacia
decreased matrix mineralization
adynamic bone
reduced bone volume and mineralization
