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Chronic Disease > Ckd Pathophysiology > Flashcards

Ckd Pathophysiology Flashcards

1
Q

Is the cause known in most cases

A

No. Only those who see a kidney specialist which is mainly on those on dialysis

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2
Q

What is the major cause in ckd

A

Diabetes

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3
Q

Intervention to reduce glycemia reduced what sign of ckd

A

Albuminuria

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4
Q

What accumulates I’m gbm which alters it’s ionic charge due to hyperglycaemia

A

Advanced glycosylated ends AGE

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5
Q

Which kinase activated in hyperglycaemia

A

Pkc

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6
Q

What does it activate which can cause hyperfiltration and damage

A

Angiotensin II

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7
Q

How can pkc stimulate renal fibrosis

A

Through tgfb

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8
Q

What gf is increased in podocytes during hyperglycaemia which causes vascular permeability in nephrons = hyperfiltration

A

Vegf

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9
Q

On avg how much GFR lost every year over 40

A

1ml

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10
Q

Is there a genetic risk

A

Yes eg African apoL1 most predominant here

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11
Q

Give 3 factors likely to cause progression to esrd

A

Underlying diabetes, hypertension and high proteinuria

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12
Q

What 2 types of fibrosis can occur which also increases risk of esrd

A

Tubulointerstitial fibrosis
And glomerulosclerosis

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13
Q

What happens in tubulointerstitial

A

Myofibroblasts accumulate and deposition of matrix in the interstitial, which widens it and separates nephron cells

Harder to get blood and nutrients from peritubular capillaries and cells become nephrotic

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14
Q

Which types of immune cells involved in scarring/fibrosis after multiple injury and inflammation

A

M2 and th2

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15
Q

How do th2 modulate m2

A

Via il4 and 13

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16
Q

How are m2 profibrogenic

A

Release tgfb

17
Q

What is mmt

A

Transition of Mac to myofibroblasts from tgfb1 inducrion

18
Q

What attracts macrophages

A

Glomerular cytokines, proteinuria, angiontensin II, injury to cells

19
Q

Why is th1 not important

A

Balances timpnwith mmp but th2 increases collagen

20
Q

Other than stimulate m2 tgfb release what do il13 do indirectly to increase fibroblast lay down

A

Cleave LAP from tgfb releasing active tgfb to bind fibroblast receptors

21
Q

Why does nephron integrity decline with age

A

Cellular senescence, ros, deceased tubular proliferation

22
Q

How can mmp2 induced by tgfb cause more fibrosis than degrade ecm

A

It degrades the bm of tubular cells allowing for EMT

23
Q

How does angiotensin II cause release of chemokines like mcp1 from epi cells attracting macrophages to kidney

A

Nfkb activation

24
Q

What can complement be activated by

A

Proteinuria which activates cells to activate complement

25
Q

How is c3a profibrotic

A

EMT tubular

26
Q

How is c5a

A

Tgfb release and macrophage chemotaxis and th2 polarisation

27
Q

What is the most effective drug to treat underlying proteinuria

A

Irvesartan

28
Q

How

A

It is a angio II receptor blocker which reduces capillary pressure so reduces filtration pressure so less proteins are filtered

29
Q

What control can be done for diabetic ckd to reduce what

A

Glycemic control to reduce proteinuria eg because glycemia increases angiotensin via pkc

30
Q

What else could you do

A

Treat blood pressure or ckd complications like anemia

31
Q

Why are drugs limiting

A

No drugs for renal fibrosis and cvd risk management has no effect on ckd

32
Q

Which glucose reuptake inhibitors now fda approved to block reabsorption from kidney of glucose = reduced hyperglycaemic effects

A

Sglt2 inhibitors

33
Q

What 2 types of dialysis are there for esrd

A

Hemodialysis (artificial kidney is drawn out of body to dialysate machine which filters the blood from excess waste/fluid)

Peritoneal dialysis - dialysate put into your peritoneal cavity and filters the blood and draws out excess solutes and waste

34
Q

In who have studies found dialysis has no survival benefit

A

Comorbidities and over 75s with esrd

35
Q

What are the issues with dialysis

A

Bad side effects

Long time eg 3 times a week for hemodialysis

Not a cure

Still mortality rates high

36
Q

What is better

A

Transplantation but waiting time is avg of 2.5 years

Chronic Disease (16 decks)

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