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Pance Re-Up > Renal #2 (CKD) > Flashcards

Renal #2 (CKD) Flashcards

1
Q

What is the MCC of end-stage renal disease?

A

Diabetes Mellitus

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2
Q

What is the MCC of end-stage renal disease?

What it the second MCC?

A

Diabetes Mellitus 1st

Hypertension 2nd

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3
Q

Name some patients who are at risk for CKD

A

-DM, HTN, Chronic NSAID use, AA, age >60, SLE, Family History of kidney disease

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4
Q

Explain the GFR in the following stages of CKD
-Stage 1:
-Stage 2:
-Stage 3:
-Stage 4:
-Stage 5:

A

1) Kidney damage with normal GFR > 90
2) GFR 89-60
3) GFR 59-30
4) GFR 29-15
5) GFR < 15: Needs dialysis

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5
Q

What is the normal GFR?

A

120-130

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6
Q

Symptoms of CKD (they are general)

A

-Uremia: N/v, AMS, metallic taste, easy bruising, cramping, hiccups, fluid overload, irritability

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7
Q

What is the single best predictor of disease progression in CKD (it is a lab)

A

Proteinuria

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8
Q

What lab is preferred to determine proteinuria

What other labs are shown in CKD (what is also seen on UA)

A

-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).

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9
Q

On renal US in CKD, what is expected?

A

Small kidneys classic

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10
Q

Regarding treatment for CKD, explain what is needed/used in the following instances

-HTN:
-Proteinuria:
-DM control:
-Hyperlipidemia:

A

-HTN: blood pressure goal < 140/90 (ACE or ARBs)
-Proteinuria: ACE or ARBs
-DM: A1c < 7.0%
-Control lipids and raise HDL

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11
Q

Dialysis is indicated if GFR _______ or less and/or serum creatinine > ________

However, in diabetics, if GFR ________ or less and serum creatinine > _______, then do dialysis.

A

GFR 10 or less and Cr > 8

GFR 15 or less and Cr > 6

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12
Q

Explain what a horseshoe kidney is and what this may entrap

A

Fusion of one pole of each kidney (MC fused at lower poles)

This may entrap the inferior renal artery

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13
Q

What are some risk factors for a horseshoe kidney

A

-Associated with other congenital urologic abnormalities (ureteropelvic junction obstruction MC, VUR)
-Turner Syndrome
-Trisomy 13, 18, 21

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14
Q

What complications should you remember with a horseshoe kidney?

A

-Urine stasis leads to pyelonephritis and kidney stone formation
-Increased risk of renal cell carcinoma

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15
Q

Although a majority of horseshoe kidneys are asymptomatic, what are some symptoms they CAN have?

A

-Hematuria
-Renal Calculi
-Pain
-Hydronephrosis due to VUR or UJO

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16
Q

Even though an US is done to detect horseshoe kidneys, what is the best initial test to evaluate the anatomy and relative renal function?

A

-CT urography

17
Q

Although a majority of horseshoe kidneys do not require treatment, if the patient has an obstruction, what should you do?

A

Refer to urologist

18
Q

On the other hand, hydronephrosis is

This is characterized by the ….

A

Urinary tract obstruction leading to dilation of the collecting system in one or both kidneys

Obstruction of passage of urine

19
Q

What are some common etiologies of hydronephrosis (think of things that OBSTRUCT)

A

-Nephrolithiasis
-BPH
-Prostate Cancer
-Tumors

20
Q

What is shown on US in hydronephrosis?

A

-Dilation of the collecting system in one or both kidneys

–THIS IS THE INITIAL IMAGING STUDY DONE

21
Q

What is the treatment for hydronephrosis?

A

Removal of the obstruction

22
Q

Adult Polycystic Kidney Disease (PKD) is an autosomal _______ disorder due to mutations of either genes _____ or _________

Explain this condition

A

Autosomal dominant

PKD1 or PKD2

Formation and enlargement of kidney cysts and cysts in other organs (liver MC, spleen, pancreas)

23
Q

What is the pathophysiology of PKD (what stimulates cystogenesis and eventually ESRD over time?

A

Vasopressin

24
Q

Symptoms of PKD

A

-Renal: Abdominal and flank pain, nephrolithiasis, hematuria, UTI
-Extrarenal: cerebral berry aneurysms (SAH), MVP, colonic diverticula

25
Q

What is seen on exam in a patient with PKD? Think about what it can cause as a secondary cause

A

-Palpale flank masses, large palpable kidneys
-Hypertension

26
Q

What is the most widely used diagnostic imaging test for PKD?

What is seen on UA?

A

Renal US

Hematuria, Proteinuria, decreased urine concentrating ability

27
Q

Management for PKD if:

-Simple Cyst:
-Multiple Cysts:

A

-Simple: observation, periodic reevaluation, ACE, ARB for HTN

-Multiple: Supportive, increased fluid intake, HTN control

28
Q

What does increasing fluid intake do to help PKD?

A

-Fluid decreases Vasopressin (reducing cystogenesis)

29
Q

What is renal osteodystrophy?

Explain the pathophysiology of this.

A

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

30
Q

What is the relationship of phosphate, PTH, and Calcium?

A

High PTH –> high Phosphate
High phosphate –> low Calcium

31
Q

Symptoms of renal osteodystrophy

A

-Bone and proximal muscle pain (in content of uremia)
-pathologic fractures

32
Q

What labs are shown in renal osteodystrophy?

A

Hypocalcemia + Increased Phosphate + increased PTH (secondary hyperparathyroidism)

-Increased alkaline phosphatase (kidneys are not removing phosphatase and it is building up in blood)

33
Q

Radiographs:
Biopsy:

Think about what is seen in renal osteodystrophy

A

-Radiographs: Periosteal erosions, bony cysts, salt and pepper appearance of skull

Biopsy: cystic brown tumors

34
Q

Treatment for renal osteodystrophy
-Think about what needs to happen to the labs

A

-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)

35
Q

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?

A

-Clear cell carcinoma

-RF: Smoking, Hypertension, Obesity, Men, Dialysis

36
Q

Symptoms of renal cell carcinoma (there is a triad), but also where are the METS to?

A

-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)

37
Q

Initial test done for renal cell carcinoma

A

-CT scan

38
Q

Management for Stage I-II for renal cell carcinoma

A

-Radical nephrectomy

-It is resistant to chemo and radiation

39
Q

another treatment that can potentially be done for RCC

A

-Immune-mediated therapy (IL-2 and monoclonal antibody molecular targeted treatment)

Pance Re-Up (76 decks)

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