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Renal Exam 2 > Lect 2 > Flashcards

Lect 2 Flashcards

1
Q

what is CKD associated with?

A

abnormal kidney function and progressive decline in GFR

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2
Q

chronic renal failure corresponds with what CKD stages?

A

Stages 3-5

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3
Q

end-stage renal disease (ESRD)

A

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

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4
Q

Stage 0

A

GFR >90 with risk factors fro CKD

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5
Q

Stage 1

A

GFR>90 w/ kidney damage (persistent proteinuria, abnormal urine sediment, abnormal blood chemistry, abnormal imaging studies)

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6
Q

Stage 2

A

GFR 60-89

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7
Q

Stage 3

A

GFR 30-59

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8
Q

Stage 4

A

GFR 15-29

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9
Q

Stage 5

A

GFR less than 15

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10
Q

consequences of glomerular hyperfiltration

A

Compression of endothelial cells → cannot really function anymore/ will be occluded → increase in capillary pressure and enlarged capillaries

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11
Q

histology of CKD

A

In chronic kidney disease, regular renal parenchyma is replaced by fibrotic tissue
Also have loss of tubules

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12
Q

risk factors for CKD

A

HTN, DM, autoimmunity (SLE!!), age, african ancestry, family history, previous episode of AKI, proteinuria, abnormal urinary sediment, structural abnormalities

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13
Q

what is the peak GFR?

A

120 mL/min

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14
Q

what is the mean decline in GFR?

A

declines 1 mL/year reaching a mean value of 70 mL/min at age 70 (mean GFR is lower in women than in men)

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15
Q

monitoring nephron injury

A

GFR, 24h urine collection (albuminuria), spot first-morning urine sample (protein to creatinine ratio)

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16
Q

monitoring nephron injury

A

GFR, 24h urine collection (albuminuria), spot first-morning urine sample (protein to creatinine ratio)

17
Q

microalbuminuria

A

excretion of amount of albumin too small to detect by regular urine dipstick
good screening test for early detection of renal disease

18
Q

stage 1 and 2 symptoms

A

• 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

19
Q

stage 3 and 4 symptoms

A

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

20
Q

stage 5

A

toxins accumulate

uremic syndrome

21
Q

LEADING ETIOLOGIES OF CKD

A
  • diabetic glomerular disease
  • glomerulonephritis
  • hypertensive nephropathy (elderly)
  • autosomal dominant polycystic kidney disease
  • other cystic and tubulointerstitial nephropathy
22
Q

pathophys of uremia

A

accumulation of toxins
anemia, malnutrition, and abnormal metabolism of carbs, fats, and proteins
progressive systemic inflammation (elevated levels of C-reactive protein)

23
Q

clinical abnormalities of uremia

A

leads to disturbances in the function of virtually every organ system

24
Q

acid/base disturbances

A

metabolic acidosis= abnormally high level of acid and low level of bicarb from inability to excrete protons

25
Q

fluid and electrolyte disturbances

A

hypovolemia, hyperkalemia (more often in DM, obstructive nephropathy, and sickle cell nephropathy), hypokalemia (rare)

26
Q

what is the leading cause of morbidity and mortality in pts at every stage of CKD?

A

cardiovascular disease

27
Q

cardiovascular abnormalities examples

A

ischemic CV disease, HTN, left ventricular hypertrophy, pericarditis, HF and pulmonary edema

28
Q

hematologic abnormalities in CKD

A

normocytic, normochromic anemia (from insufficient erythropoietin)

29
Q

abnormal hemostasis

A

prolonged bleeding time

thromboembolism in nephrotic syndrome (loss of anticoagulants)

30
Q

uremic fetor

A

urine-like odor on the breath; derives from breakdown of urea to ammonia in saliva; assoc w/ unpleasant metallic taste

31
Q

uremic fetor

A

urine-like odor on the breath; derives from breakdown of urea to ammonia in saliva; assoc w/ unpleasant metallic taste

32
Q

bone manifestations of CKD

A
  1. high bone turnover w/ increased PTH levels (osteitis fibrosa cystica)
  2. low bone turnover w/ low-normal PTH levels (adynamic bone)
33
Q

secondary hyperparathyroidism

A

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

34
Q

FGF-23

A

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

35
Q

osteomalacia

A

decreased matrix mineralization

36
Q

adynamic bone

A

reduced bone volume and mineralization

Renal Exam 2 (10 decks)

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