Chronic Kidney Disease

Question 1

criteria for different stages of CKD

Answer 1

according to GFR
Stage 1:  >89 w/ hematuria or proteinuria
Stage 2: GFR 60-89
Stage 3: GFR 30-59
Stage 4: GFR 15-29
Stage 5: GFR <15 or on dialysis

Question 2

renoprotective factors

Answer 2

tight glucose control
tight BP control (BP<130/80)
reduction of proteinuria (w/ ACEI/ARB)
others: smoking cessation, statin therapy, anemia management

Question 3

complications of CKD

Answer 3

anemia
hyperkalemia
hyperphosphatemia
secondary hyperparathyroidism
metabolic acidosis
HTN
uremia

Question 4

indications for dialysis

Answer 4

refractory acidosis, hyperkalemia or fluid overload
Uremia (esp encephalopathy, uremic pericarditis)
malnutrition

Question 5

which renal hormones decrease in CKD

Answer 5

calcitriol

EPO

Question 6

criteria for CKD

Answer 6

GFR 6 months

Question 7

CKD staging

Answer 7

CGA
cause
GFR category
Albuminuria category

Question 8

major cause of death in CKD

Answer 8

CVD

Question 9

why does CKD lead to HTN?

Answer 9

volume expansion

Question 10

CKD effect on phosphate and vit D

Answer 10

vit D deficiency

phosphate retenion

Question 11

PTH actions (4)

Answer 11

• promotes renal synth of calcitriol –> enhances calcium and phosphate absorption in the gut
• increases calcium reabsorption in DT
• decreases proximal phosphate reabsorption (by decreasing activity of Na-Phosphate transporter)
• stimulates bone resorption if there is enough calcitriol

Question 12

how does CKD cause secondary hyperparathyroidism?

Answer 12

GFR drops –> decrease in serum Ca2+ –> stimulates PTH, which brings calcium back up to normal
process continues to balance electrolytes at the expense of rising PTH
at stage 4, serum phosphorous increases b/c aren’t enough functioning nephrons to get rid of phosphate despite rising PTH

Question 13

FGF23

Answer 13

responds to increase in phosphorus –> decrease phosphate reabsorption + INHIBITS 1alpha-hydroxylase