Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

REN > chronic kidney disease > Flashcards

chronic kidney disease Flashcards

1
Q

Functions

What is the function of the kidneys

Homeostasis ones

A

Homeostasis ones
* Water/ fluid
* Electrolytes
* Acid-Base
* Blood pressure
* Elimination of waste
* Excretion of drugs & drug metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Functions

What are the endocrine/metabolic functions of the kidneys

A

synthesis of hormones
* Vitamin D
* Erythropoietin
* Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Assessing kidney function in clinical practice

what is the gold standard of kidney functioning measurements

A

Exogenous filtration markers
* E.g. inulin, 51Cr-EDTA
* Require injection or infusion
* Require multiple sample collection, so it’s quite intrsuive

Endogenous Filtration Markers
* E.g. urinary clearance of creatinine
* Requires accurate timed urine collection
-matched serum sample
- need time and mutiple samples again

only use methods when there is uncertentity about kidney functions, not used in clincial practise as much

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do we measure kidney function in clinical practise

A
  • Serum creatinine
  • use it to estimate GFR
  • not a linear relationships
  • for example when kidney function is very good will lead to big chnages in egfr
  • when kidney function is low big changes in creatnine shows up as small changes in egfr

creatnine breakdown from mucsles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What factors can affect creatanine

the non renal ones

A

creatnine: breakdown of muscles, muscle mass effects it

Non-renal determinants of serum creatinine include
- Age
- Sex
- Ethnicity
- Body habitus
- Diet

ethnicty has been dropped from the equations

For example a 20 year old with 100 serum cretanien has the egfr of 80 compared to 80 year old female with the same creatanine has 40 eGFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Proteinuria

What do injured, inflammed glomeurli/kidneys leak

A

Proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Proteinuria

How do we quantify proteinuria

A

measure total amount: proudce 24hr urine sample, (and you’ll see the amount of protein proudced over 24 hours)

Measure ratio to reference analtye
we use an albumin to creatinine ratio. to assess how much protein would be in someones urine if done over 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CKD

What is CKD

A

defined as abnormalties of kidney structure and function that has been there for over 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CKD

What if someone has normal kidney function, can they still have CKD

A

Yes

if they have protein in urine, or blood, or if they have scarring (seen on ultrasound)

some of these can point to glomeruli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage 1

What happens in stage 1 of CKD

A

when someone’s eGFR is over 90 ml per minute (that means they have normal function)

*if they have proteinuria, or blood then they have CKD stage 1

normal is about 120 ml per minute

btw when eGFR increases your confiedence decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stage 2

What is stage 2 classified as

A

eGFR is between 60-90 ml per minute

as we get older, eGFR reduces anyway

To call it CKD you need to have something

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Stage 3

What is Stage 3 CKD

A

30-60ml per minute (eGFR)

at that point you have CKD with reduced kidney function (mild-moderate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stage 3

What is the difference between stage 3a and b

A

stage 3a: 45-59
stage 3b: 44-30 (see the complications of CKD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

stage 4

What is stage 4

A

Severe kidney impairement
eGFR less than 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What happens in stage 5

A

eGFR is less than 15

atp you start dialysis, or do transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CKD

People can progress through the stages of CKD

what does this mean for the kidneys

A

it means there’s an irreverisble loss of nephrons
- so loss of renal filtration function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stage 5

What are the types of renal replacment therapies

A

Haemodialysis
Peritoneal dialysis
Kidney transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CKD

How else can we classify CKD

A

the amount of proteinuria present
A1 - normal (no proteinuria)
A2 -significant proteinuria
A3 - severe proteinuria (about half a gram of protein a day)

A3: either have signgficant CKD, or an inflamtorty disease of kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Proteinuria

Why is it important to know if someone has proteinuria

A
  • can help determine the cause
  • risk of death

can end up doing a biposy to determine cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Renal disease

What are the imporant risk factors are there

population wise, medical disease, social factors, lifestyle

A
  • Age
  • Social deprivation
  • Black or South Asian ethnicity
  • Hypertension
  • Diabetes
  • Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of Chronic Kidney Disease

What are the common causes of CKD

A
  • Diabetes
  • Hypertension
  • Genetic
  • Glomerulonephritis
  • other reasons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diabetic nephropathy

What is Diabetic nephropathy characterised by

like what will the person present with

A

proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the pathology of diabetic nephropathy

A

thickening of basement membrane
* mesangial expansion
* hyperglycaemia stimulates increased matrix production
by mesangial cells
* stimulation of TGF-b release (causes fibrosis)
* glomerulosclerosis
* due to intraglomerular hypertension or ischaemic damage
* essentially lose filtration power

hyperglycemria: increase filtration due to dilation of afferent ateriole, but you get increase glomerular pressure, causes damage with time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diabetic Nephropathy

True or flase

there is a correlation between diabetic retinopathy and Diabetic
Nephropathy

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the natural history of diabetic
nephropathy

A

cba check the lecture slides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diabetic nephropathy

How do we treat diabetic nephropathy

A

Treat underlying disease
* Good blood sugar control (diet & medications)

Reduce proteinuria
* use ACE inhibition & SGLT2 inhibitor

Limit cardiovascular risk
* Control blood pressure
* Treat hyperlipidaemia
*Stop smoking, etc.

27
Q

Hypertensive nephropathy

What is hypertensive nephropathy

A

When yo get glomerular hypertension
intermial thickiening of blood vessles
* leads to narrowing of blood vessels
* and glomerular ischaemia
* end up with proegessive CKD and firbosis due to hypertension

Glomerular hypertension causes injury and sclerosis over prolonged
periods

28
Q

Renal atery stenosis can cause CKD

what is it?

A

find answer

29
Q

Glomerulonephritis

What is glomerulonephritis

A

immune-mediated injury to glomeruli

30
Q

Glomerulonephritis

What can cause glomerulonephritis

A
  • IgA nephropathy (most common one)
  • maybe associated with infection (e.g streptococcus, HIV)
  • can be part of systemic disease process (e.g. systemic lupus erythematosus, vasculitis)
31
Q

Glomerulonephritis

How do we diagnose glomerulonephritis

A

usually there may be blood and or protein in urine

and they don’t have oher reaosns to cause this

32
Q

Autosomal dominant polycystic kidneys

What is polycystic kidneys

A

when cyst on the kidneys
the cysts replace kidney tissue so reduces function
can cause pain
- if they repture (cause haemturia)

33
Q

Polystsic kidneys

When can someone get autosmal domianat polycystic kidneys and when can someone get autosomal reccessive polycystic kidneys

A

Reccessive: manifest in childhood

Dominant: adulthood

34
Q

Causes

What else can cause CKD not mentioned

A
  • Medications (NSAIDs, chemotherapy, others)
  • Recurrent urinary tract infection
  • Urinary outflow obstruction (bladder obstruction, cause of that bengin hyperplastic prostate)
  • Trauma
  • Interstitial nephritis
  • Recurrent/ persistent acute kidney injury
35
Q

Consequences of impaired kidney function

What are the complications related to CKD

A
  • increased mortality (3)
  • cardiovascular disease & hypertension (3)
  • Altered drug handling (3)
  • Anaemia(4)
  • Vitamin D, phosphate & parathyroid disturbance(4)
  • Acidosis(4)
  • Hyperkalaemia(4)
  • Fluid retention (5)
  • Uraemia (5)

brackets allude to stages

36
Q

CVS risks in CKD

What are the tradional risks factors of CVS in CKD

A
  • Diabetes
  • Hypertension
  • Dyslipidaemia
  • Smoking

Dyslipidaemia & Smoking share some risk factors

37
Q

Cardiovascular risk in CKD

What are the non classical risks

A
  • Endothelial dysfunction
  • Inflammation
  • Oxidative stress
  • Catabolic state

how they think CKD affects CVS mortality

38
Q

Cardiovascular risk in CKD

What are the CKD related risks

A
  • Fluid retention
  • Anaemia
  • Hyperparathyroidism
  • Vascular calcification
39
Q

Why is hypertension important when it comes to ckd

A
  • can accelerates decrease of kidney function
  • Can contribute to cardiovascular risk
  • (stroke, myocardial infarct,
    heart failure)
40
Q

Hypertension

What are the mechanims that hypertension can contribute to CKD

like who can HT cause CKD

A
  • Sodium retention
  • Volume expansion
  • Renin-angiotensin-system activation
  • Sympathetic nervous system activation
  • Endothelial dysfunction
41
Q

How do we manage hypertension

A
  • Moderate salt intake
  • Renin-angiotensin system blockade
  • diuretics
  • Other anti-hypertensive
    medications
42
Q

PTH

Parathyroid hormone mechanism

and how does this affect the kidney

A
  1. Low calcium
  2. stimulates parathyroid
  3. stimulates PTH
  4. PTH acts on kidney to stimulate kidney to activate vitamin D
  5. VD acts on gut to increase calcium absoption
  6. increases serum calcium
  7. increased calcium serum which acts on parathyroid to stop PTH

if blocked
* there wil be cnstant sectreiton of PTH
* bone resoption to increase calcium
* can end up with 2nd or 3rd hyperparathyroodism

43
Q

Mineral bone disease

How do we manage mineral bone disease?

A
  • Correct Vitamin D deficiency if present (colecalciferol, ergocalciferol)
  • Supplement activated Vitamin D (alfacalcidol, calcitriol)
  • Control high phosphate levels (dietary restriction, phosphate binders)
  • Offer calcimimetics (use drugs to stop producing PTH)
  • Last resort: parathyroidectomy
44
Q

Anaemia

How can anaemia impact people’s lives

A

Impaired quality of life
* reduced exercise capacity
* impaired cognition
* increased risk of Left Ventricular
Hypertrophy
* increased CV disease in patients with CKD and anaemia compared to those with CKD without anaemia

45
Q

Anaemia

How do we treat CKD with anaemia

A
  • Correct iron deficiency if present
  • Recombinant erythropoietin

don’t give blood tranfusion all the time because of iron overload,

also don’t want to sensitise patients if they are going to recieve transplant

46
Q

Bicarbonate -carbonic acid buffer

What happens during with the bicarbonate - carbonic acid buffer system during CKD

A

CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3 -

There is adFailure to excrete acid (H) in CKD

so increase ↑ H+ -→↑H+.HCO3 → ↑CO2 +↑H2O means increased co2 and water

This is removed by lungs to maintain pH

47
Q

Metabolic Acidosis

What is the impact of Metabolic Acidosis

A

Impact
* Increased respiratory rate
* Acute – life-threatening metabolic dysfunction
* Chronic - loss of bone and muscle mass

48
Q

How do we manage metabolic acidosis

A

Management
* Sodium bicarbonate
* Dialysis (or transplantation)

49
Q

Hyperkalaemia

True or false
the body has little reserve of pottassium

A

False

it has a large functional reserve to excrete potassium

with severe hyperkalaemia happens when GFR decrease 10ml/min

50
Q

Hyperkalaemia

Why do people with hyperkalemia

A

Excessive load
* Interferance with potassium excretion
* acidosis with volume contraction
* diabetic nephropathy

51
Q

Hyperkalaemia

What can happen when pottassium goes outside normal range

A

life threatning
you can get

  • Alterations in membrane excitability
  • cardiac arrythmias

Can see ECG changes
* Tall T waves
* Long QRS interval
* Long PR interval
* Cardiac arrest

52
Q

hyperkalaemia

How do we manage hyperkalaemia

A
  • restricting dietry pottassium
  • Potassium binders (not used in CKD in clincial practise as much)
  • dialysis
53
Q

Sodium and fluid retention

what happens when there is failure of fluid retention

A
  • can’t conc urine
  • inablity to excrete water load (so can have dilutional hyponatraemia, oedma, hypertension)
54
Q

Sodium & fluid retention

What can high levels of sodium lead to

A

Confusion, fits and coma

for normal neurological function, sodium needs to be in normal rnage

55
Q

Sodium & fluid retention

What can the loss of nephrons reduce

A

ablity to excrete salt and water

which can cause hypertension and fluid overload

56
Q

Fluid overload

How do we manage fluid overload?

A

Intake (dietry)
* Reducing/restric salt
* Reducing/restrict Fluid

Output
* Diuretics
* Dialysis or transplant

57
Q

Uraemai

What is it

A

When urea is high
aren’t clearing toxins that well
may mainain nitrogenous waste, and things like urate, phosphate TNF alpha

can affect peoples brains

58
Q

What are the consequences of uraemia

life threatning ones

A

Encephalopathy
Pericarditis

Pericarditis: inflammation of oericardium, can bleed into it, bled into tight space which can compress the heart, and you can get cardiac tampondae

Encephalopathy: twiching because uranmic (indication to start dialysis)

59
Q

Drugs

Drugs are metabolsied and excreted by the kidneys

What is the consequnce of impaired renal clearance

A

Can get toxicity from high drug levels

and

prolonged action (since they aren’t being cleared)

60
Q

Drugs

What adverse effects can opiates accumliating cause

A

Reduced consciousness & respiratory arrest

61
Q

Drugs

What adverse effects can antoboitics not being cleared cause

A

Encephalopathy

can affect brain function

62
Q

Drugs

What adverse effects can lithium accumliating cause

A

Vomiting, tremors, confusion

63
Q

Drugs

What adverse effects can digoxin accumliating cause

A

arrthymias

64
Q
A

REN (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions