Flashcards in 17) Chronic kidney disease Deck (7)
what are the most common etiology for CKD ?
polycystic kidney disease
what is the pathophysiology of hypertensive nephrosclerosis ?
: chronic hypertension → narrowing of afferent arterioles and efferent arterioles → reduction of glomerular blood flow → glomerular and tubular ischemia
arteriolonephrosclerosis and fibrosis (focal segmental glomerulosclerosis)
diagnosis of hypertensive nephroslerosis ?
Initially microalbuminuria and microhematuria
With disease progression, nephrosclerosis with macroalbuminuria (usually < 1 g/day) and
Biopsy: sclerosis in capillary tufts, arterial hyalinosis
typical findings in diabetic nephropathy include a thick basement membrane, an increased mesangial matrix, fibrosis, and round nodules within the glomeruli (Kimmelstiel-Wilson nodules.)
but hypertensive predominantly affect the afferent arterioles
what are the clinical featured of CKD?
often asymptomatic until later stages.
Pulmonary edema (usually interstitial pulmonary edema)
Clinical features of uremia
Fatigue, weakness, loss of appetite, headaches
Friction rub on auscultation
Encephalopathy: seizures, somnolence, coma
Peripheral neuropathy: paresthesias
Gastrointestinal symptoms: nausea, vomiting
↑ Risk of infection: leukocyte dysfunction
↑ Bleeding tendency secondary to platelet dysfunction - abnormal aggregation and adhesion
Chronic kidney disease-mineral and bone disorder (CKD-MBD):
Etiology: mostly due to secondary
short supply of active vitamin D
hen the blood phosphorus level goes up and blood vitamin D level goes down, your body makes too much parathyroid hormone (PTH). High PTH levels cause calcium
Clinical features: weakness, fractures, bone pain, avascular necrosis
↑ Creatinine and BUN
Electrolytes: hyperkalemia, hyperphosphatemia, hypocalcemia
Monitor blood pH for metabolic acidosis
↓ Calcitriol levels
↑ Parathyroid hormone (PTH
↑ bleeding time caused by uremic coagulopathy
Anemia of chronic kidney disease: ↓
ultrasound - shrunk kidneys
stages based on GFR ?
Glomerular filtration rate (GFR) (mL/min/1.73 m2)
1 > 90 Normal or high
2 60 to 89
3 30 to 59 Moderately decreased
4 15 to 29 Severely decreased
5 < 15 = kidney failure
based on albuminuria
A1 < 30 Normal
A2 30 to 300 Mildly increased (microalbuminuria)
A3 > 300 Severely increased (macroalbuminuria)