Chronic kidney disease I Flashcards Preview

Year 2 Renal > Chronic kidney disease I > Flashcards

Flashcards in Chronic kidney disease I Deck (16)
Loading flashcards...
1
Q

definition: CKD

A

presence of KIDNEY DAMAGE or DECREASED KIDNEY FUNCTION for 3 or more MONTHS, irrespective of cause

2
Q

kidney damage is identified by the presence of one of the following:

A
  • albuminuria
  • urinary sediment abnormalities (casts)
  • electrolyte and other abnormalities due to tubular disorders
  • imaging abnormalities
  • kidney biopsy
  • kidney transplantation
3
Q

decreased kidney function is quantified as eGFR below:

A

60 mL / min per 1.73 m2

4
Q

why is it important to identify people with CKD?

A

increased risk for all-cause and CV mortality, ESRD, AKI, and CKD progression

5
Q

ESRD-causing polymorphisms are located in what gene? what is the inheritance pattern?

A
  • apolipoprotein L1 (APOL1)

- autosomal recessive

6
Q

APOL1 mutations are also associated with what conditions?

A
  • earlier onset of kidney disease

- more rapid decline in eGFR

7
Q

what is the most significant risk factor for CKD?

A

diabetes

8
Q

what is the gold standard exogenous filtration marker of GFR?

A

inulin

9
Q

what are the eGFR values for CKD stages 1-5?

A
stage I: over 90 mL/min 
stage 2: 60-89 mL/min 
stage 3: 30-59 mL/min 
stage 4: 15-29 mL/min 
stage 5: under 15 mL/min
10
Q

what are the criteria for revised stages of CKD?

A
  • cause
  • six categories of GFR
  • three categories of albuminuria
11
Q

what are the compensatory chances in renal hemodynamics seen in progressive renal failure?

A
  • increased intraglomerular pressure (systemic or arteriole mediated)
  • glomerular hyperfiltration in preserved nephrons
12
Q

how do the maladaptive changes seen in progressive renal failure cause decline in GFR?

A
  • direct endothelial cell damage
  • formation of subendothelial hyaline deposits narrow capillary lumens, decreasing perfusion and filtration
  • increased strain on mesangial cells, stimulating release of cytokines and mesangial expansion
13
Q

proteinuria alone may contribute to disease progression by which mechanisms?

A
  • mesangial toxicity
  • tubular overload and hyperplasia
  • toxicity from specific filtered compounds
  • induction of proinflammatory molecules such as monocyte chemoattractant protein-1 (MCP) and cytokines
14
Q

definition: CKD progression

A
  • decline in GFR category

- drop in GFR category accompanied by a 25% or greater drop in eGFR from baseline

15
Q

definition: rapid progression

A

sustained decline in eGFR of more than 5 mL/min/1.73 m2/yr

16
Q

what is the management for patients with CKD progression?

A
  • review current management
  • examine for reversible causes
  • consider referral