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Clinical Medicine II > Renal: CKD > Flashcards

Renal: CKD Flashcards

1
Q

MC causes of kidney failure?

A

DM, HTN

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2
Q

GFR < 60 or albumin-Cr ratio (ACR) 30+ indicates…

A

CKD

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3
Q

What stage of CKD?

GFR 90+

A

1

Kidney damage normal GFR

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4
Q

What stage of CKD?

GFR 60-89

A

2

Kidney damage mildly decreased GFR

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5
Q

What stage of CKD?

GFR 45-59

A

3a

mild-moderate decreased GFR

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6
Q

What stage of CKD?

GFR 30-44

A

3b

moderately-severely decreased GFR

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7
Q

What stage of CKD?

GFR 15-29

A

4

severely decreased GFR

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8
Q

What stage of CKD?

GFR < 15

A

5

kidney failure

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9
Q

sxs in CKD may not appear until…

A

advanced

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10
Q

Profound decreased in GFR

fatigue/malaise
pericarditis
encephalopathy/AMS

This indicates…

A

uremic syndrome

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11
Q

What two labs (non serology) are included in workup for CKD?

A

UA

Urine albumin to Cr ratio

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12
Q

What imaging can be helpful for CKD?

A

renal US

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13
Q

What finding on renal US supports CKD?

A

small kidneys bilaterally

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14
Q

CKD is an independent risk factor for…

A

CVD

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15
Q

The following are…

osteitis fibrosis cystica

adynamic bone disease

osteomalacia

A

CKD mineral and bone disorder (CKD-MBD)

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16
Q

What is the typical pattern of CKD-MBD?

A

hyperphosphatemia, hypocalcemia, decreased vitamin D

Leads to Secondary Hyperparathyroidism

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17
Q

When is CKD-MBD detectable

A

stage 3/4

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18
Q

As GFR decreases around 90, rank the 6 complications that begin showing up.

A

HTN, increased PTH, anemia, increased PO4, acidosis/hyperkalemia, uremic syndrome

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19
Q

The following are reversible risk factors for…

infx
obstruction
decreased perfusion
nephrotoxic agents
HF
A

CKD

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20
Q

This class of drugs is:
DOC
-renoprotective, slows progression of proteinuric CKD

decreases albuminuria

A

ACE/ARB

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21
Q

When can ACE-I/ARBs be harmful in CKD?

A

AKI:
can decrease GFR
cause hyperkalemia

Bilateral renal artery stenosis

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22
Q

target BP in proteinuric CKD?

A

< 130/80

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23
Q

when should you consider referral to nephrology with CKD?

A

GFR < 30

or < 60 with severe albuminuria

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24
Q

The following are indications for…

cause CKD

ACR 300+

complication mgmt (EPO, CKD-MBD)

dialysis prep

transplant eval

A

nephrology referral

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25
Q

The following are Indications for what tx in CKD

GFR < 30

Uremic Sxs

unresponsive fluid overload

refractory hyperkalemia, acidosis, hyperphosphatemia

A

dialysis

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26
Q

MC complication of hemodialysis?

A

hypotension

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27
Q

The below conditions represent what diseases of kidney?

obstructive uropathy

reflux nephropathy

analgesic nephropathy

A

chronic tubulointerstitial diseases

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28
Q

This disease refers to kidney disorder that involves the tubules and/or interstitium of kidney, sparing glomeruli

A

chronic tubulointerstitial disease

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29
Q

chronic tubulointerstitial disease is characterized by…

A

interstitial scarring, tubular atrophy leading to CKD

30
Q

The following are general findings for…

  • polyuria due to tubular damage
  • hyperkalemia due to decreased GFR, aldo. resistant DTs
  • broad waxy casts, proteinuria
A

Chronic tubulointerstitial diseases

31
Q

This is prolonged/recurrent obstruction of urinary tract with chronic reduction in GFR and impaired tubular fxn…

A

obstructive uropathy

32
Q

What can be seen on UA for obstructive uropathy?

A

bland:
hematuria
pyria
bacteria

33
Q

US for obstructive uropathy can be used to detect…

A

mass, hydroureter, hydronephrosis

34
Q

Which disease is a consequence of vesicoureteral reflux or other childhood anomaly causing fibrosis in interstitium and eventually CKD…

A

reflux nephropathy

35
Q

Reflux nephropathy is typically diagnosed in what patients?

A

young children w/ hx of recurrent UTI

36
Q

This type of CKD is caused by:

  • long term acetaminophen, NSAID use, especially as combo meds (i.e. excedrine)
  • seen w/ chronic pain, migraines
A

analgesic nephropathy

37
Q

The following lab results are concerning for what type of CKD/Chronic tubulointerstitial disease?

elevated Cr
hematuria/sterile pyuria
mild proteinuria
anemia

A

analgesic nphropathy

38
Q

CT scan in analgesic nephropathy would show…

A

renal papillary necrosis and calcification

39
Q

How do you treat chronic tubulointerstitial disorders?

A

ID underlying cause
relieve obstruction
withdrawal of analgesics

referral

40
Q

This is noninflammatory damage to glomerular capillary wall.

proteinuria > 3.5
hypoalbuminemia
edema
hyperlipidemia
foamy urine
oval fat bodies
A

Nephrotic syndrome

41
Q

Three primary causes of nephrotic syndrome…

A

minimal change disease
membranous nephropathy
focal segmental glomerulosclerosis

42
Q

The following are sxs of what syndrome?

malaise
anorexia
dyspnea
abd. distension
weight gain
ortho hypotension
A

nephrotic syndrome

43
Q

two main complications of nephrotic syndrome…

A

hyper-coagulability

Infection

44
Q

What about nephrotic syndrome that can lead to hypercoabulability?

A

urine loss antithrombin, proteins C/S

increased platelet activation

45
Q

Infection is common in nephrotic syndrome due to…

A

urinary loss of immunoglobulins

defects in complement cascade

46
Q

This is the most common cause of nephrotic syndrome in children, and is mostly idiopathic.

It can also be preceded by URI, hypersensitivity,

A

minimal change disease

47
Q

Describe the onset of sxs in minimal change disease…

A

rapid over days-weeks

48
Q

Minimal change disease primarily effects what part of the nephron?

A

podocyte

diffuse podocyte foot process fusion

49
Q

What is first line for MCD?

A

prednisone

50
Q

does MCD progress to ESRD?

A

not usually

51
Q

This disease has the following characteristics:

  • peaks 4th/5th decades
  • common form of nephrotic syndrome in adult population
A

membranous nephropathy

52
Q

Primary membranous nephropathy is thourght to be…

A

immune mediated

53
Q

The following diseases can cause…

HBV
autoimmune disease
thyroiditis
malignancy
drugs
A

secondary MN

54
Q

describe the onset of nephrotic syndrome in membranous nephropathy…

A

gradual

55
Q

membranous nephropathy makes you at higher risk of…

A

hypercoagulability (renal vein thrombosis)

56
Q

How do you treat MN?

A

supportive care

+/- immunosuppression/transplant

57
Q

This is a common cause of primary glomerular disease.

It represents a histologic pattern of kidney injury

Presentation is nephrotic syndrome

Black patients are at greater risk…

A

focal segmental glomerulosclerosis (FSGS)

58
Q

this disease:

  • glomerular injury via damaged podocytes
  • sclerosis in parts of at least one glomerulus
A

FSGS

59
Q

Primary FSGS is caused by…

A

idiopathic

60
Q

Obesity, infx, inflammation, toxin, previous glomerular injury, reflex nephropathy, HTN can be causes of…

A

secondary FSGS

61
Q

How is primary FSGS treated?

A

immunosuppressive agents

62
Q

Secondary FSGS is treated with…

A

disease specific treatment

63
Q

What factors contribute to a poor prognosis for FSGS?

A

nephrotic range proteinuria
black
renal insufficiency

64
Q

this is the most common cause of ESRD defined by structural and functional changes. It commonly occurs with retinopathy…

A

diabetic nephropathy

65
Q

4 treatment options for diabetic nephropathy…

A

glycemic/BP control
ACE/ARBs
Statin
Dialysis/transplant

66
Q

AL amyloidosis is characterized by the presence of…

A

monoclonal light chains

67
Q

AA amyloidosis is characterized by…

A

chronic inflammatory dz/infx

68
Q

What tests can screen for renal amyloidosis

A

SPEP/UPEP

69
Q

tx for renal amyloidosis?

A

refer

70
Q

what is an early sign of diabetic nephropathy?

A

albuminuria

Clinical Medicine II (31 decks)

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