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chronic disease > Clinical Impact Of Ckd > Flashcards

Clinical Impact Of Ckd Flashcards

1
Q

What is the functional unit of kidneys

A

Nephrons

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2
Q

How can PCt absorb a lot of water and small molecules like glucose

A

Brush border

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3
Q

What is descending permeable to

A

WTer only

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4
Q

What happens in ascending limb

A

Na/k/Cl cotransproter for na reabsorption and dilution of urine

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5
Q

What hormone is released during low bp/flow to kidneys

A

Renin

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6
Q

What does this do

A

Angiotensin 1 conversion to 2

Production of aldosterone (enac na reuptake ar collecting duct)

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7
Q

Which cells are in late dct and collecting duct

A

Intercalating for HCO/h balance

Principal for removal of k and regulated na and water reabsorption

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8
Q

What makes the 3 glomerular filtration barriers in the renal corpuscle

A

Fenestrated wndothelial
Glomerular basement membrane
Podocytes with filtration slits

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9
Q

What do endothelial cells have which causes electrostatic repulsion as negative charge with protein

A

Glycocalyx layer with sialoproteins like podocalyxin

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10
Q

What makes gbm negative too

A

Heparan sulphate pgs (it is an ecm)

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11
Q

What do podocytes have that’s negative

A

Sialogps also eg podocalyxin

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12
Q

How many A is max size for filtration

A

30

So albumin and large proteins and rbc not filtered

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13
Q

what is the filtration pressure calculation

A

Fp = capillary pressure - (colloid osmotic from plasma protein + bc fluid pressure)

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14
Q

What needs to happen to increase filtration pressure

A

Vasoconstriction of efferent eg via angiotensin

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15
Q

What is used to measure kidney function

A

GFR

Vol cleared/unit time/1.73m(sa)

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16
Q

Why isn’t urine output a determinant of kidney function

A

Some will have same output

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17
Q

Why is creatinine perfect to be used to measure GFR

A

Freely filtered and not reabsorbed

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18
Q

How is it produced

A

Creatine from liver stored in muscle gets degraded to creatinine

19
Q

Why is this not sensitive at higher gfrs (ie can’t detect early stages of GFR loss)

A

Because signchanges in Cr plasma only occur at v low GFR

It is an exponential relationship

So at higher GFR like 50 the cr in plasma similar to 90

20
Q

What is the normal GFR

A

90+ ml

21
Q

What does GFR levels not account for

A

Cr levels in people

Muscle mass difference in gender, elderly, amputees, liver disease

22
Q

Why could women be over diagnosed or men misdiagnosed as normal

A

Low cr to begin with

High and limited change in men

23
Q

What is used to estimate GFR from Cr levels of blood and why not urine

A

Urine would need 24 hour collection

Can use formulas which deteeemine likely GFR based on serum cr and ethnicity, gender and age

24
Q

What 3 things can be done to quantify proteinuria / hematuria

A

Dipstick test

Urine collection/ urinalysis for 24 hours

Albumin/Cr ratio from spot urine sample

25
Q

Why does nice recommend the ratio

A

It accounts for differences in hydration level. As both decrease in conc as hydration goes up the cr allows adjustment to hydration levels

(Conc would be more if less hydrated)

26
Q

What mg/mmol is normal of albumin

A

3mg or below

27
Q

How long do you need to have dysfunction according to nkf-kdqoi fuidelines

A

3 months

28
Q

What does GFR need to be reduced to

A

60 or below

29
Q

What does g1 to g5 mean

A

G1 is relatively normal GFR but some proteinuria so early stage of ckd

G5 is below 15mls GFR so is kidney failure

30
Q

What does A1 to A3 mean

A

A1 is normal albumiurea but a3 is over 30mg/mmol

31
Q

What is the limitations of these guidelines

A

Use an estimated GFR based on formulas like mdrd which could misdiagnose based on age or gender etc

32
Q

Is ckd common in uk

A

Yes around 4 million people

33
Q

What is the likely demographic

A

Over 70s, women

34
Q

What are common comorbidities with ckd especially as you decrease GFR down further

A

Hypertension, cvd , diabetes

35
Q

Give some reasons why prevalence is increasing

A

More illnesses like diabetes II
or hypertension

More ethnically diverse with Africans having more ckd risk

36
Q

Why can hypocalcemia from kidney disease cause secondary osteodystrophy

A

Vit d not activated by kidneys so can’t absorb calcium from gut

The parathyroid tries to compensate by removing calcium from bones

37
Q

Why is pulmonary oedema / edema in general common in ckd

A

Water retention

38
Q

What is link between anorexia and urea

A

Uraemia in ckd can cause poor appetite

39
Q

Which hormone from kidney is reduced in ckd causing iron deficiency and anemia

A

EPO

40
Q

What other symptoms can uraemia cause

A

Fatigue, itchiness, nausea , pericarditis

41
Q

What is the impact on mortality in lower egfr

A

Increased risk at eg g4

42
Q

What else is increased risk as ckd progressives

A

Cv events and hospitalisation

43
Q

Which non fatal events can microalbuminurea cause

A

Pulmonary edema and ventricular arrhythmia

44
Q

What increased risk of death after myocardial infarction

A

Microalbuminuria

chronic disease (16 decks)

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