Renal #2 (CKD) Flashcards
What is the MCC of end-stage renal disease?
Diabetes Mellitus
What is the MCC of end-stage renal disease?
What it the second MCC?
Diabetes Mellitus 1st
Hypertension 2nd
Name some patients who are at risk for CKD
-DM, HTN, Chronic NSAID use, AA, age >60, SLE, Family History of kidney disease
Explain the GFR in the following stages of CKD
-Stage 1:
-Stage 2:
-Stage 3:
-Stage 4:
-Stage 5:
1) Kidney damage with normal GFR > 90
2) GFR 89-60
3) GFR 59-30
4) GFR 29-15
5) GFR < 15: Needs dialysis
What is the normal GFR?
120-130
Symptoms of CKD (they are general)
-Uremia: N/v, AMS, metallic taste, easy bruising, cramping, hiccups, fluid overload, irritability
What is the single best predictor of disease progression in CKD (it is a lab)
Proteinuria
What lab is preferred to determine proteinuria
What other labs are shown in CKD (what is also seen on UA)
-Spot Urine Albumin/UCreatinine Ratio (ACR) preferred over 24 hour urine collection
-Increased BUN and Cr
-UA: Broad waxy casts seen in ESRD (taking the shape of dilated and damaged tubules).
On renal US in CKD, what is expected?
Small kidneys classic
Regarding treatment for CKD, explain what is needed/used in the following instances
-HTN:
-Proteinuria:
-DM control:
-Hyperlipidemia:
-HTN: blood pressure goal < 140/90 (ACE or ARBs)
-Proteinuria: ACE or ARBs
-DM: A1c < 7.0%
-Control lipids and raise HDL
Dialysis is indicated if GFR _______ or less and/or serum creatinine > ________
However, in diabetics, if GFR ________ or less and serum creatinine > _______, then do dialysis.
GFR 10 or less and Cr > 8
GFR 15 or less and Cr > 6
Explain what a horseshoe kidney is and what this may entrap
Fusion of one pole of each kidney (MC fused at lower poles)
This may entrap the inferior renal artery
What are some risk factors for a horseshoe kidney
-Associated with other congenital urologic abnormalities (ureteropelvic junction obstruction MC, VUR)
-Turner Syndrome
-Trisomy 13, 18, 21
What complications should you remember with a horseshoe kidney?
-Urine stasis leads to pyelonephritis and kidney stone formation
-Increased risk of renal cell carcinoma
Although a majority of horseshoe kidneys are asymptomatic, what are some symptoms they CAN have?
-Hematuria
-Renal Calculi
-Pain
-Hydronephrosis due to VUR or UJO
Even though an US is done to detect horseshoe kidneys, what is the best initial test to evaluate the anatomy and relative renal function?
-CT urography
Although a majority of horseshoe kidneys do not require treatment, if the patient has an obstruction, what should you do?
Refer to urologist
On the other hand, hydronephrosis is
This is characterized by the ….
Urinary tract obstruction leading to dilation of the collecting system in one or both kidneys
Obstruction of passage of urine
What are some common etiologies of hydronephrosis (think of things that OBSTRUCT)
-Nephrolithiasis
-BPH
-Prostate Cancer
-Tumors
What is shown on US in hydronephrosis?
-Dilation of the collecting system in one or both kidneys
–THIS IS THE INITIAL IMAGING STUDY DONE
What is the treatment for hydronephrosis?
Removal of the obstruction
Adult Polycystic Kidney Disease (PKD) is an autosomal _______ disorder due to mutations of either genes _____ or _________
Explain this condition
Autosomal dominant
PKD1 or PKD2
Formation and enlargement of kidney cysts and cysts in other organs (liver MC, spleen, pancreas)
What is the pathophysiology of PKD (what stimulates cystogenesis and eventually ESRD over time?
Vasopressin
Symptoms of PKD
-Renal: Abdominal and flank pain, nephrolithiasis, hematuria, UTI
-Extrarenal: cerebral berry aneurysms (SAH), MVP, colonic diverticula
What is seen on exam in a patient with PKD? Think about what it can cause as a secondary cause
-Palpale flank masses, large palpable kidneys
-Hypertension
What is the most widely used diagnostic imaging test for PKD?
What is seen on UA?
Renal US
Hematuria, Proteinuria, decreased urine concentrating ability
Management for PKD if:
-Simple Cyst:
-Multiple Cysts:
-Simple: observation, periodic reevaluation, ACE, ARB for HTN
-Multiple: Supportive, increased fluid intake, HTN control
What does increasing fluid intake do to help PKD?
-Fluid decreases Vasopressin (reducing cystogenesis)
What is renal osteodystrophy?
Explain the pathophysiology of this.
Bone disorders (osteitis fibrosa cystica and Osteomalacia) associated with CKD
Failing kidneys do not eliminate phosphate properly (increase phosphate) and simultaneously, poorly synthesize Vitamin D
-This leads to increase in PTH and decreased bone mineralization
What is the relationship of phosphate, PTH, and Calcium?
High PTH –> high Phosphate
High phosphate –> low Calcium
Symptoms of renal osteodystrophy
-Bone and proximal muscle pain (in content of uremia)
-pathologic fractures
What labs are shown in renal osteodystrophy?
Hypocalcemia + Increased Phosphate + increased PTH (secondary hyperparathyroidism)
-Increased alkaline phosphatase (kidneys are not removing phosphatase and it is building up in blood)
Radiographs:
Biopsy:
Think about what is seen in renal osteodystrophy
-Radiographs: Periosteal erosions, bony cysts, salt and pepper appearance of skull
Biopsy: cystic brown tumors
Treatment for renal osteodystrophy
-Think about what needs to happen to the labs
-Phosphate binders: Calcium carbonate and Calcium acetate (to lower phosphate and increase Calcium)
-Sevelamer (used if Ca+ and Ph+ levels both high)
-Supplement with Vitamin D (Calcitriol) and Calcium
-Cinacalcet (lowers PTH)
A renal cell carcinoma, which is a tumor the proximal convoluted renal tubule cells, are 95% of the primary tumors arising in the kidneys. What is the MC type?
What are some risk factors?
-Clear cell carcinoma
-RF: Smoking, Hypertension, Obesity, Men, Dialysis
Symptoms of renal cell carcinoma (there is a triad), but also where are the METS to?
-Triad: Hematuria, flank/abdominal pain, palpable abdominal mass
-Hypertension and Hypercalcemia common
-Left-sided varicocele: if tumor blocks left testicular vein drainage
-Cannonball mets to lungs (MC)
Initial test done for renal cell carcinoma
-CT scan
Management for Stage I-II for renal cell carcinoma
-Radical nephrectomy
-It is resistant to chemo and radiation
another treatment that can potentially be done for RCC
-Immune-mediated therapy (IL-2 and monoclonal antibody molecular targeted treatment)
