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Nefrologia PT > Chronic Kidney Disease Part 2 > Flashcards

Chronic Kidney Disease Part 2 Flashcards

1
Q

one or both: abnormalities of ca, phos, PTH, vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth or strength, vascular or other soft tissue calcification

A

CKD-MBD

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2
Q

alteration of bone morphology in patients with CKD, one measure of skeletal component

A

renal osteodystrophy

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3
Q

most important regulator of intestinal absorption of Phos

A

high dietary Phos

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4
Q

major site of intestinal calcium absorption

A

duodenum

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5
Q

vitamin D independent nonsaturable pathway

A

paracellular pahtway

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6
Q

vitamin D dependent, saturable pathway

A

transcellular pathway

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7
Q

inactivation of CaSR: Calcium and PTH

A

decrease in Calcium, increase PTH secretion

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8
Q

most important determinant of minute to minute secretion of PTH From stored secretory granules

A

extracellular concentration of ionized calcium

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9
Q

major source of the circulating levels of calcitriol

A

kidney

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10
Q

circulating factors that regulate phos excretion

A

phosphatonins - FGF23 and MEPE

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11
Q

surrogate of bone turnover in patients with CKD

A

PTH

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12
Q

bone turnover, microarchitecture, microfractures and mineralization

A

bone quality

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13
Q

alignment of strands of collagen has an irregular woven pattern

A

osteitis fibrosa cystica

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14
Q

histologically by absence of cellular activity, osteoid formation and endosteal fibrosis

A

low turnover (adynamic bone disease)

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15
Q

excess of unmineralized osteoid, wide osteoid seams, decreased mineralization rates

A

osteomalacia

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16
Q

bone biopsies with secondary hyperparathyroidism with mineralization defect: extensive osteoclastic and osteoblastic activity and increased endosteal peritrabecular fibrosis

A

mixed uremic osteodystrophy

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17
Q

assess the presence or absence of vascular calcification

A

plain radiographs

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18
Q

Vit D deficiency

A

less than 10 ng/mL

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19
Q

vit D insufficiency

A

10-30 ng/mL

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20
Q

decreased stratum corneum hydration and abnormal eccrine gland function

A

xerosis

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21
Q

mainstay of treatment of xerosis

A

hydration of skin

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22
Q

cause of hyperpigmentation

A

increased melanin production, inc B melanocyte stimulating hormone

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23
Q

mainstay of treatment of calciphylaxis

A

supportive and preventive measures

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24
Q

calcium deposits in the tissue

A

metastatic calcification

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25
Q

trauma may result to

A

dystrophic calcification

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26
Q

vascular proliferation near or over an AV shunt

A

pseudo-kaposi’s sarcoma

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27
Q

bound down indurated skin, cobblestone apperance, edema and erythema early on; exposure to gadolinium

A

nephrogenic systemic fibrosis

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28
Q

Histopath: increased dermal and/or subcutaneous fibroblast-like cells
cells stain with procollagen I and CD34

A

nephrogenic systemic fibrosis

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29
Q

rare complication of fistula construction leading to decreased distal perfusion involving brachial area

A

dialysis associated steal syndrome

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30
Q

pallor or a reticulated pink to blue discoloration of the skin with necrosis, ulceration or gangrene

A

dialysis associated steal syndrome

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31
Q

effective treatment of dialysis associated steal syndrome

A

fistula ligation and/or binding

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32
Q

B2 microglobulin deposition, carpal tunnel syndrome and destructive arthropathy

A

dialysis related amyloidosis

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33
Q

leukocytoclasia, fibrin thrombi, nonblanching papules and plaques in lower extremities

A

leukocytoclastic vasculitis

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34
Q

Birt Hogg Dubb syndrome is associated with what renal findings

A

renal cell carcinoma

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35
Q

adenoma sebaceum associated with angiomyolipoma

A

tuberous sclerosis

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36
Q

port wine stain, cysts, clear cell renal cell Ca

A

VHL syndrome

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37
Q

diagnosis of DKD

A

urine ACR 30 mg/g or higher, eGFR < 60 ml/min

38
Q

most important risk factor in DM

A

duration

39
Q

screening of DKD in type 2 DM is recommended at

A

time of diagnosis

40
Q

screening of DKD in type 1 DM is recommended after

A

5 years of type 1 DM

41
Q

important predictor of progression of advanced kidney disease, clinical hallmark of diabetes

A

hyperglycemia

42
Q

abnormalities in heart rate and vascular dynamics: resting tachycardia and orthostatic hypotension

A

cardiac autonomic neuropathy

43
Q

best currently available risk marker for DKD

A

albuminuria

44
Q

hallmark of DKD

A

accumulation of extracellular matrix

45
Q

early finding in DKD

A

tubular basement/GB membrane thickening

46
Q

first lesion detected by light microscopy

A

mesangial expansion

47
Q

first lesion identified by electron microscopy

A

GBM thickening

48
Q

prominent round expansion of hypocellular mesangial matrix with palisading mesangial cells in the periphery of the nodule surrounded by glomerular capillaries

A

nodular glomerulosclerosis, kimmelstiel wilson nodules

49
Q

where can nodular glomerulosclerosis be seen

A

DKD, light chain deposition disease, immune complex processes, idiopathic nodular glomerulosclerosis

50
Q

fraying of the mesangial matrix, precursor of nodular lesions

A

mesangiolysis

51
Q

subendothelial accumulations of hyaline in the glomerular capillary

A

fibrin caps

52
Q

accumulation of hyaline under the parietal epithelial cell lining of Bowman’s capsule

A

capsular drops

53
Q

Kidney biopsy in DM patients

A

sudden onset proteinuria, onset of proteinuria less than 5 years from type 1 DM, proteinuria in absence of retinopathy, AKI, active urinary sediment, hematuria

54
Q

Class 3 DKD Glomerular lesions

A

nodular lesions (KWL_ at least one

55
Q

RAAS blocker of choice: Type 1 DM, Htn, Albuminuria

A

ACEi

56
Q

Type 2 DM. htn, microalb RAAS blocker

A

ARB

57
Q

Overt DKD

A

ARB

58
Q

target Hba1c for prevention of DKD

A

7%

59
Q

treatment goal of dyslipidemia

A

LDL < 70-100

60
Q

protein intake for DKD

A

0.8 g/kg/day

61
Q

DM patients on dialysis with spontaneous resolultion of hyperglycemia with Hba1c less than 6%

A

Burnt-out DM

62
Q

screening for anemia should begin at CKD stage

A

stage 3

63
Q

EPO is produced in what cells within renal cortex

A

peritubular interstitial cells, fibroblasts

64
Q

low hepcidin

A

iron mobilization

65
Q

high hepcidin

A

iron overload

66
Q

gold standard to monitor patients with iron overload disorders

A

liver magnetic resonance imaging

67
Q

decrease ferritin

A

vitamin C deficiency, hypothyroidism

68
Q

threshold tsat value below which iron therapy is indicated

A

20%

69
Q

dual markers of iron status as well as of nutritional and protein balance

A

transferrin and TIBC

70
Q

most sensitive indicator of functional iron deficiency

A

Retic Hegmoglobin content

71
Q

reversal agent for LMW and UFH

A

protamine sulfate

72
Q

thrombocytopenia 5-10 days after the start of heparin therapy, persistence of any acute thrombotic event, normal platelet count before heparin, trhombocytopenia with no other causes; resolution after heparin cesation; HIT antibody seroconversion

A

heparin induced thrombocytopenia

73
Q

first 2 days after exposire to heparin and platelet count normalizes with continued heparin therapy

A

Type 1 HIT

74
Q

immune mediated disorder that typically occurs 4-10 days after exposure to heparin and has life and limb threatening thrombotic complications

A

Type 2 HIT

75
Q

acute confusional state characterized by recent onset of fluctuating awareness, disorganized thinking, impairment of memory and attention

A

delirium disorders

76
Q

syndrome of delirium seen in inadequately treated ESKD - lethargy, confusion and seizures or coma

A

uremic encephalopathy

77
Q

headache, visual disturbance, nausea, agitation,

A

dialysis dysequlibrium

78
Q

syndrome of progressive dementia related to aluminum intoxication

A

dialysis dementia

79
Q

management of chronic cognitive impairment mild to moderate dementia

A

cholinesterase inhibitors

80
Q

treatment of moderate to severe Alzheimer’s dementia

A

Memantine

81
Q

distal symmetric, mixed sensorimotor polyneuropathy, symmetric muscle weakness, areflexia and loss of vibratory sense

A

uremic polyneuropathy

82
Q

compression or ischemia of the ulnar or median nerves and often dialysis related, amyloidosis or AVF

A

mononeuropathy

83
Q

repetitive cessation of respiration during sleep

A

sleep apnea

84
Q

apnea associated with continued respiratory effort

A

obstructive

85
Q

apnea associated with absence of respiratory effort

A

central

86
Q

treatment of sleep apnea

A

CPAP

87
Q

urge to move the legs associated with feelings of discomfort or paresthesias

A

restless leg syndrome

88
Q

first line therapy for more severe symptoms

A

levodopa

89
Q

second line for restless leg syndrome

A

gabapentin

90
Q

sudden and repetitive movements of the lower extremities during sleep

A

periodic limb movements of sleep

Nefrologia PT (112 decks)

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