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Urology > Lecture 6 - Chronic Kidney Disease > Flashcards

Lecture 6 - Chronic Kidney Disease Flashcards

1
Q

what is the gold standard for early detection of kidney disease?

A

GFR

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2
Q

what is normal GFR level?

A

3.5 - 4.5

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3
Q

what kidney functions are impaired in CKD?

A
  1. excretory functions - nitrogenous wastes, P, K, meds, etc
  2. regulatory functions - fluids, electrolytes, acid-base, minerals, BP
  3. synthetic/endocrine function - Vit D, EPO, angiotensin-renin system
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4
Q

10 clinical problems seen in CKD

A
  1. azotemia
  2. dehydration
  3. UTI
  4. metabolic acidosis
  5. anemia
  6. hypertension
  7. electrolyte disorders
  8. hyperparathyroidism
  9. drug interactions
  10. uremia side effects: GI disturbances, neuromuscular dz, etc.
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5
Q

what is the most important treatment for azotemia?

A

decreasing the protein in the diet!!

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6
Q

what are 3 basic treatments for azotemia?

A
  1. decreasing protein in diet
  2. provide good quality diet - alter protein-calorie malnutrition
  3. treat inappetence by controlling nausig and vomiting
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7
Q

role of azodyl in tx CKD

A

it is an enteral dialysis used to help resolve azotemia

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8
Q

why are CKD patients more likely to get UTIs?

A

because they can’t concentrate their urine anymore making it easier for bacteria to grow

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9
Q

why do CKD patients get metabolic acidosis? what should serum bicarb be?

A

bc they are losing bicarb in the urine.

want to maintain serum bicarb > 20mEq/L

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10
Q

what causes anemia in CKD patients? how is it tx?

A

caused by EPO deficiency (EPO is produced by peritubular capillary endothelial cells and fibroblasts)

tx by: blood transfusions, recombinant human EPO and dabopoetin

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11
Q

when do CKD patients get hypertension?

A

in advanced IRIS stages

- the more progresive the CKD, the worse the hypertension and hte more uremic crises you get

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12
Q

consequences of hypertension in CKD patients in kidney

A

the higher the BP, the more likely to get proteinuria

  • decreases GFR
  • glomeruloscloersis
  • tubular ischemia
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13
Q

effects of hypertension in CKD patients in teh brain and eye

A
  • hypertensive encephalopathy
  • stroke

eye:

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14
Q

effects of hypertension on CV in CKD patients

A

LV hypertrophy
cardiomegaly
murmurs

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15
Q

effects of hypertension in CKD patients on glomerular autoregulation. how is it tx?

A
  • causes hydrodynamic endothelial damage
  • increases protein permeability
  • induces inflammatino

tx
- ACE-inhibitors: enalapril and benazapril

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16
Q

Amlodopine

A

Ca-channel blocker

  • dilates AFFERENT vessels
  • decreases total vascular resistance ie it lowers systemic BP
  • works fast
  • PROBLEM: it blocks renal autoregulation. this means in dogs you must first give an ACE-inhibitor to protect the glomerulus because it causes urinary PG excretion (~ vasodilation) to decrease.
17
Q

Enalapril, Benazepril

A
  • ACE-inhibitor
  • vasodilates EFFERENT vessels
  • mild anti-hypertensive, start with this then go to amlodopine
  • ** anti-proteinuric **
18
Q

mineral disorders seen in CKD patients

A

hypoK

hyperP

19
Q

why does hyperparathyroidism develop in CKD patients? describe the pathogenesis

A

in an effort to “maintain normalcy” of serum P and Ca as CKD progresses.

pathogenesis: decrease calcitriol production which decreases Ca and increases P retention

20
Q

what are the clinical consequences and Tx of hyperparathyroidism?

A

clinical consequences:

  • renal osteodystrophy, bone pain
  • PTH toxicity - increases cytosolic Ca
  • dystrophic calcification

tx
- restrict P in diet
- intestinal P binder (never give > 180 mg/kg/day).
Al-based = hydroxide (most potent), carbonate
Ca-based = acetate, carbonate, citrate
Non-Al, non-Ca = sevelamer, lanthanum

21
Q

you can slow progression of CKD by:

A
  1. diet - lower protein and P
  2. control BP with Ace-I and Ca-channel blocker
  3. proteinuria - diet and Ace-I
  4. N-3 poly-unsaturated fatty acids
22
Q

what are the effects of Ace-I?

A
  1. decreases proteinuria
  2. decreases glomerular capillary pressure - which slows fibrosis of glomeruli
  3. decreases systemic BP
23
Q

two types of CKD are?

A
  1. glomerular diseases –> loss of permaselectivity
    - proteinuric kidney disease
    - protein loss increased with hypertension
  2. interstitial disease –> loss of permeability
    - azotemic kidney disease = decreased GFR

Urology (10 decks)

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