Chronic Kidney Disease (Exam 3)

Question 1

Chronic kidney disease

Answer 1

Abnormalities in kidney structure or function for >3 months

Question 2

CKD can progress to ____ where ___ is needed to sustain life

Answer 2

End stage renal disease

Dialysis or kidney transplant

Question 3

Criteria for CKD

Answer 3

GFR <60 for >3 months
OR
GFR > 60 with evidence of kidney damage for > 3 months

Question 4

Evidence of kidney damage

Answer 4

Albuminuria (>30)
Urine sediment abnormalities
Electrolyte abnormalities due to tubular disorders
Persistent hematuria
Structural abnormalities on imaging
Abnormalities detected by histology
History of kidney transplant

Question 5

Highest risk factors for CKD

Answer 5

Diabetes and HTN

Question 6

KDIGO Staging of CKD

Answer 6

Cause of CKD
GFR criteria (G1-G5)
Albuminuria category (A1-A3)

Question 7

Cause of CKD

Answer 7

Primary - confined to kidney
Secondary - systemic (diabetes, autoimmune, infections)

Question 8

GFR

Answer 8

Glomerular Filtration Rate
Volume of plasma filtered across glomerulus per unit time

Question 9

Normal GFR

Answer 9

Males: 127 +/- 20
Females: 118 +/- 20

Question 10

GFR Category 1

Answer 10

> 90
Normal or high w/ kidney damage

Question 11

GFR Category 2

Answer 11

60-89
Mild decrease w/ kidney damage

Question 12

GFR Category 3a

Answer 12

45-59
Mild-moderate decrease

Question 13

GFR Category 3b

Answer 13

30-44
Moderate-severe decrease

Question 14

GFR Category 4

Answer 14

15-29
Severely decreased

Question 15

GFR Category 5

Answer 15

<15
Kidney failure

Question 16

End Stage Renal Disease (ESRD)

Answer 16

Stage 5 CKD/GFR <15 AND requires dialysis or kidney transplant

Question 17

Endogenous markers of GFR

Answer 17

creatinine or cystatin-c

Question 18

Exogenous markers of GFR

Answer 18

iohexol, inulin, iothalamate

Question 19

Most commonly used GFR measurement

Answer 19

Estimates GFR (eGFR)

Question 20

Measured GFR (mGFR)

Answer 20

based on exogenous markers
costly, time consuming

Question 21

eGFRcr

Answer 21

based on SCr

Question 22

eGFRcr-cys

Answer 22

based on SCr and cystatin-c

Question 23

Drug trials have historically used ____ for drug dosing

Answer 23

CrCl

Question 24

Differences between GFR (CKD-EPI) and CrCl

Answer 24

GFR is more accurate
CrCl is inconsistent

Question 25

Albuminuria Categories

Answer 25

A1-A3

Question 26

Category A1

Answer 26

AER <30 ACR <30

Question 27

Category A2

Answer 27

AER 30-300 ACR 30-300

Question 28

Category A3

Answer 28

AER >300 ACR >300

Question 29

Albumin does NOT get filtered in ___ Why?

Answer 29

glomerulus Large size

Question 30

Healthy individuals excrete

Answer 30

30-150 mg/day of total protein 30 mg/day of albumin

Question 31

How is albuminuria measured?

Answer 31

Albumin-to-creatinine ratio (ACR) Albumin Excretion Rate (AER)

Question 32

Common complications of CKD

Answer 32

Altered sodium and water balance Hyperkalemia Metabolic acidosis Anemia Mineral and bone disorder CV disease

Question 33

Additional CKD Complications

Answer 33

Amyloidosis Blood and immune disorders Endocrine and GI abnormalities Protein-energy wasting Neurologic abnormalities Uremic pruritus

Question 34

Compensation for CKD eventually leads to

Answer 34

Intraglomerular HTN Glomerular hypertrophy Decrease in functioning nephrons Impaired glomerulus filtration

Question 35

Filtered protein is ____ to kidney tubular cells

Answer 35

toxic

Question 36

There's a decrease in erythropoietin production in CKD which leads to

Answer 36

anemia

Question 37

Anemia of CKD

Answer 37

Normochromic and normocytic

Question 38

Which stages of CKD is erythropoietin impaired?

Answer 38

Stages 3-5

Question 39

Iron deficiency is common in _____

Answer 39

stages 3-5

Question 40

Causes of iron deficiency in CKD

Answer 40

decreased GI absorption frequent blood testing blood loss from HD increased iron demands inflammation

Question 41

RBC lifespan in CKD stage 5

Answer 41

60 days

Question 42

CKD-mineral and bone disorder abnormalities

Answer 42

PTH Calcium Phosphorus vitamin D FGF-23

Question 43

CKD-MBD abnormalities lead to

Answer 43

bone disorders decreased vitamin D and Ca sensing receptors increased CV events increased mortality and morbidity

Question 44

Hyperphosphatemia and hypocalemia triggers

Answer 44

PTH secretion and FGF023 production

Question 45

Effects of increased PTH

Answer 45

increased Ca reabsorption in distal tubule increased Ca from bone decreased phosphate reabsorption in proximal tubule

Question 46

Effects of increased FGF-23

Answer 46

Increased phosphate excretion in kidney

Question 47

As CKD worsens, kidneys stop responding to

Answer 47

PTH and FGF-23

Question 48

___ decreases in CKD

Answer 48

Calcitriol

Question 49

Decreased calcitriol results in

Answer 49

increases PTH decreased intestinal Ca absorption

Question 50

Calcitriol deficiency worsens ____

Answer 50

hyperPTH

Question 51

CKD is _____ in stages 1-3

Answer 51

asymptomatic

Question 52

Signs of CKD

Answer 52

Edema Weight gain Decreased UOP Foaming of urine Abdominal distention

Question 53

Decreased Lab Values

Answer 53

eGFR Hgb, Hct, Tsat, Ferritin Vitamin D Albumin Glucose Calcium

Question 54

Increased Lab Values

Answer 54

SCr, BUN K, Ca, Phosphorous PTH FGF-23 Albumin + protein in urine Glucose LDL + TG