05.16 - CKD (Huch) - PP, No reading Flashcards Preview

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Flashcards in 05.16 - CKD (Huch) - PP, No reading Deck (93):
1

What % loss of nephron mass results in increase risk of HTN, Proteinuria

50%

2

Creatinine has to be ___ to use to estimate GFR

Stable, steady state

2

Stage 5 CKD

GFR <15 or Dialysis

3

Renal H+ secretion into urine is synonymous with

Addition of new bicarb into blood

3

Acid Base dysfunction in CKD and why

Decr ability to excrete acid -> Decr new bicarb -> Metabolic Acidosis with Normal AG

3

Diuretic used for BP

Thiazide

4

Urine output in CDK

Still have urine until very end (surprisingly)

4

Most important element to determine glomerular vs tubular disease

Urinalysis

5

Net result of GI effects of Renal Insufficiency

Protein Calorie Malnutrition

6

ACEi's and ARB's reduce systemic pressure and are unique in

reducing glomerular capillary pressure

7

Nervous system changes in early to moderate renal insufficiency

Intellectual function, particularly concentrating

8

3(4) Factors suggesting Tubular etiology over Glomerular

Absence of heavy proteinuira; Inability to dilute or concentrate urine (Gsp 1.010); Hyperkalemia and Metabolic Acidosis out of proportion to degree of renal insufficiency

8

How does muscle mass affect Screatinine readings

If higher muscle mass, serum creatinine will normally be higher and will under-estimate GFR

8

Common manifestation of overt encephalopathy

Asterixis

9

Pressure Natriuresis curve for Essential HTN

Shifted Right and Decreased Slope

11

Most common cause of eosinophils in urine

Allergic Interstitial Nephritis

12

Endocrine abnormalities with advanced renal failure

Fasting Hypoglycemia

14

Does CKD progress even if initial injuring stimulus is removed?

Yes

14

Signs and Symptoms of Uremia

Nausea, Vomiting, Anorexia, Confusion, Encephalopathy, The Flap

14

Early changes in Diabetic Nephropathy

Hyperfiltration resulting in glomerular capillary HTN and Glomerular Hypertrophy

15

3 Disease Dependent mechanisms of Nephron Injury

Vascular, Glomerular, Tubular

16

HTN promotes nephron loss in which types of renal diseases

All: Tubular, Glomerular, Vascular

17

Primary route for excretion of PO4

Kidney

17

When do you not give Epo

Iron deficient

18

Nomograms are useful only in

Steady State Conditions - Chronic Renal Insufficiency

18

Most life threatening electrolyte abnormality

Severe Hypokalemia

19

What do ACEi's and ARB's reduce that make them superior to other anti-HTN in CKD

Glomerular capillary pressure and Proteinuria

19

First abnormality in Diabetic Nephropathy

Microalbuminuria

20

Symptoms of chronic kidney disease

Most commonly asymptomatic

20

Why Anemia in advanced renal failure

Diminished EPO production

21

While creatinine conc increases as a function of GFR, BUN increases as function of

GFR and Urine Flow Rate

22

What has been shown to preserve renal fxn in both proteinuric and non-proteinuric renal diseases

Maintenance of normal BP with anti-hypertensives and dietary Na restriction

23

Anemia in CKD occurs at what GFR

30% of normal

24

Main thing to control in chronic kidney disease

BP

26

Most common cause of Advanced Kidney Disease

DM

27

What increases after 5/6 nephrectomy

SNGFR, Glomerular Pressure, Glomerular Volume, Urine Albumin --> Sclerosis

28

4 common symptoms of chronic kidney disease

Peripheral Neuropathy, Bone changes (high PTH), Small echogenic kidneys, Waxy casts

28

Result of increased TGF-beta by RAAS activation

Fibrosis

30

How does protein restriction affect GFR

Protein intake normally raises it transiently

31

Greater than 50% loss of nephron mass results in dose dependent increase in risk of

HTN, Protein (focal segmental glomerulosclerosis)

32

CKD is best throught of as

Loss of functioning nephrons

33

How does GFR affect 1a-Hydroxylase and 1,25(OH)2

Decr GFR -> Decr 1a-Hydroxylase -> Decr 1,25(OH)2

34

Can nomograms be used for Chronic Renal Insufficiency

Yes, not acute

34

Type of Anemia in CKD (PBS findings)

Normocytic, Normochromic with Burr Cells

35

Pressure Natriuresis curve for Aldosterone-Stimulated Kidneys

Very decreased slope, not shifted right

35

Can Nomograms be used for Acute Renal Failure

No, must be steady state

36

Histology of Diabetic Nephropathy

Increased mesangial matrix, Glomerular Collapse, Glomerulosclerosis

37

Pressure Natriuresis curve for Loss of Renal Mass

Significantly decreased slope, not shifted right

37

GI effects of Renal Insufficiency

Decreased appetite, Nausea (gastroparesis, happens on empty stomach), Vomitting --> Net result is protein calorie malnutrition

39

Chronic Renal Insufficiency equals a reduce

number of normally functioning nephrons

40

Stage 2 CDK

60-89

42

What decreases after 5/6 nephrectomy

Number of Glomerular Epithelial cells, Kf

44

Prevalance of Nephropathy in DM

30-40% of type 1, unknown in type 2

45

Why Fasting Hypoglycemia in advanced renal failure

Decreased Insulin degradation, Decreased gluconeogenesis by kidney

46

Which GFR formula is most commonly reported in hospital labs

MDRD equation

48

Pros and Cons of Protein Restriction

Reduces workload of glomerulus, but poor adherence and promotes malnutrition

49

Allergic Interstitial Nephritis is characterized by

Presence of Sterile Pyuria

50

Late Chronic Renal Failure is associated with what CV changes

Marked Anemia, Volume Overload -> CHF, Pericarditis

52

Volume status in essential HTN in advanced CKD patients

Normal volume status until GFR becomes depressed

53

Renal response to nephron loss

Compensatory Glomerular Hypertophy and Hyperfiltration

54

What causes low Vit D in renal insufficiency

Decr GFR and HyperPhosphatemia -> Decr 1a-Hydroxylase -> Decr 1,25(OH)2

56

What is an echogenic kidney

White on US - likely chronic

57

Will serum creatinine over or under-estimate true GFR

OVER

58

__ in remaining nephrons may mask the presence of nephron loss

Increased filtration

59

Term used to describe signs and symptoms associated with advanced renal failure

Uremia

60

What percent of patients with Advanced CKD have HTN

85-90%

61

Nervous system changes: More severe failure can lead to

Overt encephalopathy, often manifested by Asterixis; Peripheral Neuropathy

62

In proteinuric diseases, which class of drugs has been shown to have a selective advantage over other anti-HTN

ACEi's and ARB's

63

Last electrolyte for which homeostasis is lost

K

65

3 Factors suggesting Glomerular over Tubular

2+ or greater proteinuria; RBC casts; Gsp > 1.015

66

Diuretic used for advanced kidney disease

Loop

67

Adverse effects of Hyperphosphatemia

(1) Inhibit 1a-Hydroxylase; (2) Enhance PTH directly; (3) Metastatic Calcification

69

What percent of HTN in advanced CKD patients is volume driven

80%

70

3 Consequences in Trade-Off Hypothesis

Secondary HyperParathyroidism (Ca, PO4), Hypertension (Na), Hyperaldosteronism and HTN (K)

71

RBC Casts =

Glomerular etiology

73

What is Uremia

Term used to describe signs and symptoms associated with advanced renal failure

75

Which anti-HTN drugs reduce glomerular capillary pressure

ACEi's and ARB's

77

When are creatinine clearance and nomograms useless

When Creatinine is changing

78

Stage 3 CKD

GFR 30-59

79

Early Chronic Renal Failure is associated with what cardiac changes

HTN --> LV Hypertrophy

80

Which organ systems are affected by chronic renal insufficiency

Virtually all

80

Maintenance of normal BP has shown to preserve renal fxn in which class of renal diseases

Both Proteinuric and Non-Proteinuric

81

2 main signs of chronic kidney disease

Small, shrunken kidneys; Waxy casts

82

What causes >10:1 BUN:Creatine ratio

Pre-renal Azotemia, Dehydration -> Decr urine flow rate -> Decr excretion of Urea -> Disproportionate increase in BUN

83

Adverse effects of RAAS other than Na retention and systemic vasoconstriction

Glomerular HTN (efferent art constriction), Increased release of TGF-beta --> Fibrosis

85

Stage 4 CKD

GFR 15-29

86

Do damaged nephrons function appropriately?

Generally, yes - therefore, loss of renal homeostasis is due to decreased numer

88

How does GFR affect Ca absorption in gut

Decr GFR -> Decr 1a-Hydroxylase -> Decr 1,25(OH)2 -> Decr Ca absorption

89

Patients with __ should be in the highest risk group fro CVD, irrespective of ___

CDK, irrespective of traditional CVD risk factors

90

Uremia is 100% fatal unless

Reversible factors found that can improve GFR; Renal replacement tx

91

One of the first things that will increase in blood with renal insufficiency

Phosphorus

92

Best Anti-HTN's to use in CKD

ACEi's and ARB's

93

Which anti-HTN decrease proteinuria more than others

ACEi's and ARB's