Chronic kidney injury Pt 1 Flashcards
(76 cards)
1
Q
CKD definition
A
progressive loss of renal function over time
2
Q
what is CKD clinically based on
A
GFR and creatinine
3
Q
diagnosis of CKD requires
A
decline in kidney function over 3 months and
evidence of kidney damage or GFR <60
4
Q
End stage kidney disease=
A
when kidney function is insufficient to maintain life without RRT
5
Q
main causes of CKD (5)
A
- diabetes
- hypertension
- PKD
- GN
- recurrent UTIs
6
Q
signs/symptoms of CKD
A
hypertension azotaemia hyperkalaemia metabolic acidosis anaemia hypocalcaemia
7
Q
what type of anaemia in CKD
A
normochromic normocytic due to lack of EPO
8
Q
metabolic acidosis causes
A
SOB
9
Q
hypocalcemia due to
A
vitamin D deficiency
10
Q
stage G1 =
A
> 90
11
Q
stage 2=
A
60-89
12
Q
stage 3a
A
45-59
13
Q
stage 3b
A
30-44
14
Q
stage 4
A
15-29
15
Q
stage 5
A
<15
16
Q
management of CKD stage 1/2 without uremia
A
ACEi or ARB
statin
diuretics
Calcium channel blocker
17
Q
name 2 non-dihydropyridine calcium channel blockers
A
Diltiazem
Verapamil
18
Q
danger of ACEi and spironolactone
A
hyperkalaemia
19
Q
additions for management of stage 3/4
A
- Ezetimibe
- additional antihypertensives- thiazides, spironolactone, beta blockers
- EPO stimulating agent
- iron supplements
- calcitriol
- oral bicarbonate
20
Q
calcitrol=
A
active 1,25 vitamin D therapy
21
Q
treatment of stage 5 ESRD
A
dialysis or kidney transplant
22
Q
when is oral bicarbonate indicated
A
when bicarbonate levels lower than 15mmol/L
23
Q
Azotaemia in CKD due to
A
impaired function of the kidney urea is not effectively filtered and removed
24
Q
3 consequences of raised urea
A
pruitus
encephalopathy
N&V
25
only way to treat uremia
dialysis
26
why anaemia in CKD
lack of EPO
27
treatment of anaemia in CKD
IV EPO stimulating agent
28
Bp target for people with CKD
<130/80
29
why oedema in CKD
due to proteinuria and blood hypoalbuminemia decreasing blood osmolarity
30
treatment of oedema
IV furosemide
31
what can high doses of IV furosemide cause
ototoxicity
32
why hyperlipidemia in CKD
bi-product of synthesis of albumin is low-density lipoprotein
33
treatment of hyperlipidemia =
statins with or without ezetimibe
34
bone metabolism in the kidney
hydroxylation of inactive 25(OH) vit D to active 1,25(OH)2 vit D
35
in CKD what happens to bone metabolism
Vit D deficiency means less absorption of calcium from gut therefore increased PTH stimulating osteoclast to release calcium from bone
36
whats it called when kidney function is effected by an obstruction in urinary flow
obstructive nephropathy
37
hydronephrosis=
dilation of the renal pelvis
38
common causes of obstructive uropathy (4)
- renal calculi
- BPH
- prostate cancer
- bladder tumours
39
what is often related to unilateral obstrutive uropathy
renal calculi
40
what is often related to obstructive nephropathy
BPH
41
pathophysiology of obstructive nephropathy
back-flow of urine causes increased pressure and a hydronephrosis resulting in reduced renal blood flow, decreased GFR, ischaemia and increased RAAS
42
end result of obstructive nephropathy in the kidney
atrophy and apoptosis of renal tubules, interstitial tissue fibrosis via macrophage infiltration
43
high pressure within the tubules in obstructive nephropathy causes
reabsorption of Na, water and urea
44
lab results of obstructive nephropathy
hypernatremia
low urinary Na
high BUN: cr ratio
high urine osmolarity
45
risk factors for obstructive uropathy (7)
```
BPH
constipation
medications
urolithiasis
parkinson's
MS
malignancy- prostatic, bladder, cervical and colon
```
46
physical side effects of haemodialysis (5)
- fatigue
- insomnia
- bone and joint pain
- loss of libido
- dry mouth and anxiety
47
physical complications of peritoneal dialysis (6)
- peritonitis
- abdominal pain
- weight gain
- fever and rigors
- N&V
- increased risk of umbilical hernia
48
why is delirium seen in dialysis patients
electrolyte imbalances
49
average waiting list for kidney transplant
>3 years
50
2 types of dialysis
haemodialysis
| peritoneal
51
more efficient dialysis=
haemodialysis
52
times /week of haemodialysis
3 days
53
times/ week of peritoneal dialysis
everyday
54
what are antibodies
glycoproteins part of the immunoglobulin superfamily
55
what is the antigen-binding fragment (Fab) composed of
one constant and one paratope variable domain
56
what determines the Fab region
idiotype
57
what is a paratope
the variable antigen-binding site on the Fab domain
58
what is the fragment crystallisable region (Fc domain)
the constant tail region of the antibody
59
what does the Fc domain interact with
immune effect cells to coordinate the appropriate response to antigen
60
what determines the heavy domain
isotype
61
what does the isotype/ Fc domain determine
the function of an antibody
62
what antibodies do Naive B cells express
IgM and IgD
63
how are other antibodies formed
by class switching after antigen exposure in the germinal centre of the lymph nodes
64
first antibody expressed during B cell development=
IgM
65
structure of IgM and function
- pentameric connected by central J chain
| - major antibody in primary immune response -complement cascade as well
66
most abundant immunoglobulin in serum =
IgG
67
what does IgG do
helps bacterial immobilisation and neutralise toxin and viruses
68
only antibody that can cross the placenta=
IgG
69
IgA is secreted in the
respiratory and intestinal tract- mucosal immunity
70
shape of IgA
2 monomeric proteins connected by J chain
71
antibody present in the lowest concentration in the blood plasma=
IgE
72
main antibody for allergic reactions=
IgE -induce mast cells, eosinophils and langerhan cells
73
main categories of antibody action=
neutralisation
agglutination
precipitation
complement activation
74
aggulatination=
many antibodies bind to foreign cells forming aggregating clumps inducing phagocytosis by macrophages
75
precipitation=
many antibodies bind to serum-soluble antigens forming a precipitant which recruits macrophages and phagocytosis
76
what can an activated B cell differentiate into (2)
plasma cell
| memory cell
