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Flashcards in 11.2: Clinical II Deck (43):
1

What is chronic kidney disease?

- Progressive decline in GFR
- At least 3 months
- w/ or w/o proteinuria
- 75% cause by Htn. or TIIDM

2

What does CKD put you at risk for?

- All forms of CV disease
- Only 2% require RRT: renal replacement therapy
- Number is so low because MOST DIE FROM CVD

3

Five stages of CKD?

I: > 90, with some kidney damage
II: 60 - 89 GFR
III: 30 - 59 GFR, most common group
IV: 15 -29 GFR
V:

4

What are the main causes of CKD in the US?

TII DM and HTN: 75% of cases!

5

How does diabetes cause CKD?

- Leads to angiopathy of the glomerular capillaries
- Causes diffuse glomerular sclerosis
- Leads to nephrotic range proteinuria
- Occurs 15 - 25 yrs post diagnose with uncontrolled sugar and htn accelerating progress

6

What is leading cause of death in young diabetics?

- CKD cause from angiopathy of glomerular capillaries

7

How does Htn lead to nephropathy?

- Causes hyaline arteriolar sclerosis of renal vessels
- Resulting ischemia damages tubes and glomerulus
- Protein/hematuria can occur but are not common

8

What is renovascular htn?

- NOT THE SAME as hypertensive nephropathy
- Form of secondary htn. from renal artery stenosis
- In comparison, hypertensive nephropathy occurs in small vessels

9

Other names for hypertensive nephropathy?

1. Hypertensive nephrosclerosis
2. Benign nephrosclerosis

10

5 types of glomerulonephritis?

1. IgA nephropathy: most common cause
2. Post-infectious glomerulonephritis
3. Membranoproliferative glomerulonephritis
4. Lupus nephritis
5. Rapidly progressive glomerulonephritis

11

What is IgA nephropathy?

- IgA deposits on glomeruli leading to CKD 25%
- Presents as hematuria 1 - 2 days post URI

12

Person with bronchitis, peeing blood, dysmorphic RBCs in urine with high BUN and Cr.?

IgA nephropathy

13

What is post-infectious glomerulonephritis?

- Usually from strep skin infection (impetigo) or strep pharyngitis
- IC get lodged in glomerular basement membrane
- Complement activation leads to destruction of GBM
- 2 - 4 weeks post initial infection
- ASO titre high w/ low serum complement

14

What is the following characteristic of?
- 2 - 4 weeks post initial infection
- ASO titre high w/ low serum complement

Post-infectious glomerulonephritis

15

What is Membranoproliferative glomerulonephritis?

- Deposits in GBM and mesangium
- Complement activation leading to glomerular destruction
- DOES NOT effect mesangium

16

What is thrombophilia?

Tendency to form blood clots

17

What is RPGN?

"Rapidly progressive glomerulonephritis"
- High numbers crescents seen on biopsy

18

What are crescents on biopsy indicative of?

RPGN

19

Common causes of RPGN"

1. Goodpasture syndrome
2. Wegener's granulomatosis
3. SLE

20

4 Types of nephrotic syndrome?

1. MCD
2. FSGS
3. Membranous nephropathy
4. Amyloidosis

21

Characteristics of nephrotic syndrome?

- Proteinuria
- Bland histology
- Lack of urinary sediment

22

What is MCD?

- Type of nephROTIC syndrome common in kids
- More common in history of autoimmunity
- Steroid and ACEI can treat for good outcome

23

What is FSGS?

- Most common cause of nephrOTIC syndrome in adults
- Can appear secondary to HIV, heroin use
- Poor response to therapy

24

What is membranous nephropathy?

- Can be seen in stage V lupus, heb B, drugs, tumors
- Treated with immunosuppression

25

What are clinical features of amyloidosis?

1. Heart failure
2. Enlarged tongue
3. Skin lesions
4. GI disease
5. Polyneuropathy: Carpal tunnel

26

What is heart failure with, carpal tunnel and enlarged tongue characteristic of?

Nephropathy from amyloidosis

27

What is cholesterol atheroembolic disease?

- Cholesterol released from plaque into blood stream
- Usually occurs after surgical or interventional
- Happens weeks after procedure

28

Symptoms of cholesterol atheroembolic disease?

1. Fever / malaise
2. Digital gangrene
3. Livedo reticularis: rash
4. Renal failure

29

What is livedo reticularis?

Rash characteristic of cholesterol atheroembolic disease?

30

How to treat stage II / III CKD?

"Conservative renoprotection"
1. Promote healthy living: no smoking, exercise, weight loss
2. BP and lipid control
3. Glycemic control
4. ACEI / ARB

31

Management of stage IV CKD?

1. Nephrology referral
2. BP

32

When to call nephrologist in CK?

Stage IV

33

How does CDK lead to mineral bone disorders?

- Decrease P excretion, increased serum P levels
- Decreased Vit. D activation decreases serum Ca and Ca absorption
- End result increase in serum PTH leading to secondary hyperparathyroidism

34

How to treat hyperparathyroidism?

- Restrict dietary phosphate or with meds

35

What contributes to anemia in CDK/

1. Decreased EPO synthesis
2. Blood loss
3. Lower RBC half life

36

Treatment goals for anemia?

Hgb: 10 - 12
Transferrin saturation: 20 - 50%
Ferritin: 100- 800

37

Outcomes with ESRD?

- 20% die in within first two years on hemodialysis
- 13 hospital days and 2 admission on avg per year

38

Why are ESRD death rates higher in US than in Europe and Japan?

- US ptns often have higher rate of CVD as well
- Different dialysis practice

39

How to treat ESRD?

1. HgB 10 - 12
2. Use arteriovenous fistulas whenever possible
3. Ca 8.4 -9.5
4. P: 3.5
5. Albumin > 4
6. Nutrition consult

40

Benefits of arteriovenous fistulas?

- Eliminate central venous catheter use
- Less bacteremia and venous thrombosis
**Nearly impossible to place of ptn. has vascular disease
***Takes months to prep before it can be used

41

What is hemodialysis?

- Diffusion of molecules in solution across semipermeable membrane along electrochemical gradient
- Restores body fluids resembling normal renal environment
- Urea moves out, bicarb moves in

42

What is ultrafiltration?

- Goal of removing excess body water
- Hydrostatics and osmotics drive process
- No change in solute []s

43

What are the sequelae of ESRD?

Uremic cardiovascular disease leading to:
• Medial vascular calcification
• Arterial stiffness
• LV hypertrophy
• Higher risk of cardiac arrest and heart failure