chronic kidney disease

Question 1

CKD is present if either of the following is present for 3 or more months

Answer 1

1. structural or functional abnormalities of the kidney, with or without decreased GFR
2. GFR< 60 ml/min/1.73 with or without kidney damage

Question 2

indication of CKD (2)

Answer 2

1. proteinuria (albumin to creatinine ration > 30 mg/g)

2. history of kidney transplantation

Question 3

risk factors for CKD

Answer 3

1. older age
2, family history
3. US racial/ethnic minority status,
4. diabetes
5. HTN
6. autoimmune dx

Question 4

CKD develops when there is no apparent regulation of levels of

Answer 4

nitrogenous wastes

Question 5

initial injury of one kidney leads the remaining kidney to maintain GFR and solute level. over time the adaptations are maladaptive and leads to

Answer 5

glomerular/tubular hypetrophy and fibrosis

Question 6

what therapies do we consider with CKD

Answer 6

interefere with glomerular adaptations such as decrease PGC and decrease growth factors

Question 7

true or false:

in ckd we want the Renin system to be activated

Answer 7

false; we want to inhibit it to lower blood pressure, decrease urine production and slow the decline in GFR

Question 8

what type of diet do we want to avoid in CKD?

Answer 8

high protein diet

—- we want to reduce nitrogenous waste

Question 9

GFR>90, widspread damage with albuminuria and is sever nephrotic syndrome occures

Answer 9

kidney damage with normal or increased GFR- G1

Question 10

GFR= 60-90

Answer 10

kidney damage with midly reduced GFR- G2

Question 11

GFR= 30-59

• common pathological features irrespective of cause
• tubular adaptations and systemic adaptations

Answer 11

moderately reduced GFR- G3

Question 12

GFR= 30-59

• prepare for replacement therapy
• psychosocial preparation- lifestyle changes and dietary restrictions
• physical preparation- AV fistula, evaluation for transplant

Answer 12

severely reduced GFR- G4

Question 13

GFR < 15

• common pathologic features of ESKD
• indications for renal replacement therapy

Answer 13

kidney failure - G5

Question 14

AEIOU

Answer 14

A- acidosis
E- electrolytes 
I- intoxication
O- overload 
U- uremia

Question 15

Acidosis clue for replacement therapy

Answer 15

metabolic acidosis that cannot be controlled with medical therapy such as NaHCO3

Question 16

electrolytes clue for replacement therapy

Answer 16

electrolyte abnormalites such as hyperkalemia that cannot be treated with medical therapy

Question 17

intoxication clue for replacement therapy

Answer 17

drugs that cannot be cleared by kidney

Question 18

overload clue for replacement therapy

Answer 18

fluid overload unresponsive to dietary Na restriction or diuretics

Question 19

uremia clue for replacement therapy

Answer 19

accumulation of metabolic wastes

Question 20

clinical action plan for G1

Answer 20

diagnose and treat the cause

Question 21

clinical action plan for G3

Answer 21

adjust medication dosages as indicated and evaluate and treat complications

Question 22

A1

Answer 22

normal to mildly increase

AER <30

Question 23

A2

Answer 23

moderately increased

AER 30-299

Question 24

A3

Answer 24

severely increased

AER > 3000

Question 25

clinical action plan of A2

Answer 25

Renin blocker and lower BP

Question 26

clinical action plan of A1

Answer 26

diagnose and treat the cause

Question 27

initiation of CKD

Answer 27

1. reduced nephron number | 2. increased solute load- like in diabetes

Question 28

what is the driving pressure for hyperfiltration

Answer 28

SNGFR

Question 29

is the SNGFR increased or decreased in CKD

Answer 29

increased

Question 30

hyperfiltration hypothesis

Answer 30

nephrons adapt to increased solute load per nephron by increasing SNGFR but the adaptations are maladaptive causing initiation and progression of kidney disease

Question 31

_______ and _________ cause hemodynamic injury

Answer 31

vasodilation and increased PGC

Question 32

release of growth factors stimulate hypertrophy and ______

Answer 32

fibrosis

Question 33

_____ is a consequence of abnormal premeability to macromolecules which stimulates fibrosis

Answer 33

proteinuria

Question 34

The uremic complications include

Answer 34

hypertension, anemia, malnutrition, bone disease, neuropathy, and decreased quality of life.