Renal: Lecture 3

Question 1

Where do nephrons live in kidney?

Answer 1

Medulla and Cortex

Drain into renal pelvic

Question 2

Inactive form of vitamin D

Answer 2

25 (OH) - D

Question 3

Active form of Vitamin D

Answer 3

1,25 (OH)2D

Question 4

Proposed mechanisms for CKD progression

Answer 4

Diabetes mellitus
Systemic Hypertension
Glomerulosclerosis

Question 5

How do we get CKD from Systemic Hypertension

Answer 5

Increase in glomerular capillary pressure

Thickening of blood vessels, reducing blood flow, leading to decreased perfusion, so body will activate RAAS to try to address and makes it all worse

Question 6

How do we get CKD from Diabetes mellitus

Answer 6

High glucose = high glucose in urine causing damage in cells. Causes scaring, Mesangial cells will expand pushing on blood vessels to constrict them.

High glucose can also lead to oxidative stress leading to dec GFR and loss of nephron

Question 7

How do we get CKD from Glomerulosclerosis

Answer 7

Scar tissue is developed in Glomerulus

Question 8

Hypertension CKD Pathogenesis

Answer 8

Hypertension leads to thickening and narrowing of artery and afferent arteriole.

Decrease in GFR, causes Renin secretion and Activation of RAAS.

RAAS leads to more hypertension

Question 9

Modifiable CKD Risk factors

Answer 9

*Diabetes
*Hypertension
Hyperlipiddemia
Tobacco use
Proteinuria
History of AKI

Question 10

Non-modifiable CKD Risk factors

Answer 10

Age 60+
FH of kidney disease
Ethnicity: AA, Hispanic, Asian, American Indian

Question 11

Common causes of CKD

Answer 11

• Hypertension
• Diabetes

Acute kidney injury
Polycystic kidney disease
Other (Meds, etc)

Question 12

Physical Signs of CKD

Answer 12

Swelling/Edema
Back pain
Blod in urine
Decreased urine output
Frothiness of urine
** Usually Asymptomatic, Especially early stage**

Question 13

Labs present for CKD

Answer 13

Either of these must be present for >3 months

eGFR <60
UACR >30
Markers of kidney damage (1 or more0

Question 14

Markers of Kidney Damage

Answer 14

Urinalysis abnormalities
Kidney biopsy abnormalities
Polycystic kidney disease on imaging studies

Question 15

Differences between AKI and CKD

Answer 15

AKI: Short time frame, Double in SCr

CKD: Over prolonged period of time, dec eGFR and inc UACR

Question 16

GFR gives estimation of….

Answer 16

function and filtration

Question 17

UACR provides info regarding

Answer 17

Extent of kidney damage

Question 18

GFR decrease with age

Answer 18

1ml/min after 30 years old

Question 19

MDRD equation is…

Answer 19

more acurrate if eGFR is <60

Question 20

CKD-EPI equation is….

Answer 20

more accurate than MDRD if actual GFr >60

Question 21

GFR of a health individual is estimated to be about….

Answer 21

100-120ml/min

Question 22

Cockcroft-Gault is used for….

Answer 22

Creatine clearance, which is used for Drug Dosing

Question 23

Cockcroft-Gault equation and IBW equation

Answer 23

Male: ((140-age) X IBW)/(SCr X 72
IBW = 50 + 2.3(# in over 5ft)

Female: ((140-age) X IBW)/(SCr X 72) * 0.85
IBW: 45.5 + 2.3(# in over 5ft)

Question 24

A1 Albuminuria Stage

Answer 24

<30, now termed normal to mildly increased

Question 25

A2 Albuminuria Stage

Answer 25

30-300, microalbuminuria moderately increased

Question 26

A3 Albuminuria Stage

Answer 26

>300, macroalbuminuria severely increased

Question 27

Nephrotic Syndrome Stage

Answer 27

>2000mg

Question 28

Stage 1 CKD

Answer 28

Kidney damage with normal kidney function 90-100% | GFR >90

Question 29

Stage 2 CKD

Answer 29

Kidney damage with mild loss of kidney function 60-89% | GFR 60-89

Question 30

Stage 3a CKD

Answer 30

Mild to moderate loss of kidney function, 45-59% | GFR 45-59

Question 31

Stage 3b CKD

Answer 31

Moderate to severe loss of kidney function, 30-44% | GFR 30-44

Question 32

Stage 4 CKD

Answer 32

Severe loss of kidney function, 15 to 29% | GFR 15-29

Question 33

Stage 5 CKD

Answer 33

Kidney Failure, <15% | GFR <15

Question 34

When is renal replacement therapy considered?

Answer 34

Stage 5 (ESRD) Ex. Dialysis or Kidney Transplant

Question 35

Clinical presentation of CKD Stage 1/2

Answer 35

Increase SrCr, BUN, decrease GFR Electrolyte abnormalities maybe Possible anemia (low incidence), monitor Hgb/Hct

Question 36

Indications for Dialysis

Answer 36

``` A: Acidosis E: Electrolyte abnormalities I: Ingestion of toxic dialyzable substances O: overload of fluid U: Uremia ```

Question 37

Treatment goals of CKD

Answer 37

Delay progression of CKD Minimize development of complications, including CVD Decrease incidence of ESRD and need for dialysis

Question 38

Primary prevention of CKD

Answer 38

Preventing development of CKD

Question 39

Secondary prevention of CKD

Answer 39

Preventing progression of CKD and associated complications

Question 40

Tertiary prevention of CKD

Answer 40

Treating Kidney Failure

Question 41

BP goal for CKD based on KDIGO

Answer 41

** < 130/80 **

Question 42

Lifestyle recommendations for CKD patients

Answer 42

Lower dietary protein intake if GFR <30 Avoid high protein intake in adults with CKD at risk Lower salt to <2g Control salt, potas, phos and protein in advanced CKD 30min 5/week physical activity Healthy BMI 20-25 Tobacco cessation

Question 43

Patient education for CKD

Answer 43

influence of risk factor modification on disease progression Clinical sequelae of disease progression Pharmacologic therapies and lifestyle modifications Importances of checking w/ pharmacist on OTC meds/supplements/etc

Question 44

Self-care counseling in CKD

Answer 44

NSAIDs should be avoided Antacids calcium containing safest choice ex. AlkaSeltzer, Pepcid, Magnesium, PPI = avoid?