Diseases Quiz 2

Question 1

Chronic Kidney Disease

Answer 1

Definition: GFR 60, + family hx, or on nephrotoxic drug.

Proper treatment can delay progression and save billions.

1. ) Treat reversible causes of renal dysfunction (pre-renal - dehydration, hypotension; Renal - nephrotoxic drugs; Post-renal - stone, BPH)
2. ) Preventing or slowing the progression of renal disease (ACEi or ARBs, HTN, Protein restriction), hyperlipidemia, glycemic control, weight control, and smoking)
3. ) Treatment of complications of renal dysfunction (volume overload, hyperkalemia, metabolic acidosis, hyperphosphatemia, hyperparathyroidism - consequence of PO4 increase, anemia)
4. ) Preparation and initiation of renal replacement therapy

Sx: Volume overload, hyperkalemia, metabolic acidosis, hyperphosphatemia, hyper PTH, Anemia, osteroporosis/osteomalacia.

Question 2

Secondary Hyperparathyrodisim

Answer 2

Increased PO4; low calcium, low vitamin D –> increase PTH –> increase bone resorption, calcium reabsorption in gut and nephron, increased PO4 renal secretion, increased alpha-1-hydroxylase activation in proximal tubules (increased activation of vit. D)

Treat w/ vitamin D analogs (calcitrol, doxecalciferol, paricalcitol) after treating high PO4- (binding agents); can use Cinacalcet if high PO4-