Flashcards in Chronic Renal Failure CIS Deck (64):
1
stage 1 CKD
GFR > 90
*diabetics
2
stage 2 CKD
GFR 60-89
3
stage 3 CKD
GFR 30-59
4
chronic kidney disease**
stage 3 for 3 months
5
70% of CKD**
HTN or DM
then GN and cystic disease
then prostate and tubulointerstitial disease
6
important signs of CKD
bone disease
anemia
broad waxy casts
paresthesias
bilateral small kidneys
7
decreased GFR causing HTN
decreased sodium > turns on sympathetics > turns on RAAS
therefore - get sodium and water retention
8
bone disease and CKD
PTH
-normally inhibits P reabsorption and increases Ca reabsorption
-CKD - no 1,25 hydrox of Vit D
-decreased PTH and no Ca reabsorption
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phosphate vs. calcium
decreased GFR
-PTH can't get rid of P
-P goes up, and Ca goes down
10
decreased GFR and P/Ca
increased P and decreased Ca
11
Vit D metabolism
1 hydrox - liver
25 hydrox - kidney (prox tub)
-therefore don't get Vit D
-calcium low
12
low Ca
activates PTH release
-increased osteoclast bone resorption
-get osteitis fibrosia cystica
13
anemia and CKD
no erythropoietin
14
isosthenuria
same concentrated urine
-with CKD
15
waxy broad casts
chronic renal disease
16
subepithelial deposit humps
IgG and C3
hematuria and RBC casts
complement low
immune complex disorder
-post-infectious GN
shunt -staph
17
synpharyngitic hematuria
same time as infection
post-strep week later**
18
mesangium
IgA nephropathy
-most common in world
19
prognosis with proteinuria?
more proteinuria - gets worse
20
bergers disease
IgA nephropathy
-IgA1 - galactose deficiency in O-linked glycans
diseases with altered IgA - hepatic cirrhosis, HIV, CMV, celiac disease
21
IgA nephropathy with arthralgia, nausea, colic, melena, rash
henoch-schonlein
22
heamturia, rash, P-ANCA, RBC casts
microscopic polyangitis
23
P-ANCA
microscopic polyangitis (churg strauss)
-no granulomatous inflammation and no upper resp involvement**
24
C-ANCA
granulomatosis with polyangitis
-wegeners
25
pauci immune
not immune complex
-but instead neutrophil activation
ANCA type**
26
formation of ANCAs
MPO - antibodies to strong cations - pANCA
PR3 - antibodies to neutral/weak cations - cANCA
27
pANCA
anti-MPO - strong cations
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cANCA
anti-PR3 - neutral/weak cations
29
anti-GMB disease
alpha 3 chain of type IV collagen
30
linear antibody deposition
goodpasture
or anti-GMB GN
31
hematuria, hepatosplenomegaly, cold night purpura, RBC casts, hep C positive
essential mixed cryoglobulinemia
32
cryoglobulinemia
hep C
-antibodies against antibodies
33
cold aggultinin
mycoplasm
34
type 1 cryoglobulinemia
cancers of blood and immune system
35
type 2 and 3 cryoglobulinemia
autoimmune diseases and viruses (Hep C)
36
ultimate causes of lots of disorders
malignancy
autoimmune
infection
drugs
37
best initial treatment for most CKD patients
ACE inhibitors
-unless Cr over 3**
38
type I MPGN
subendo and subepi
-complement low (C3 and C4)***
-tram-tracking
typically with Hep C virus
39
type II MPGN
-complement normal
-dense deposit disease
40
Hep C virus**
1 type I MPGN (nephritic
2 mixed cryoglobulinemia (nephritic)
3 membranous nephropathy (nephrotic)
41
type II MPGN
dense deposit disease
-alternate complement
-C3 low, C4 normal***
-ribbon like deposits
42
low C3
type II MPGN
43
low C3 and C4
type I MPGN
44
Tx for nephritic
ACE (-)** - for proteinuria
methylpredisolone for proteinuria > 1 g/day and GFR >70
cyclophosphamide for GFR <70 and prediction to ESRD within 5 years
45
black, HIV, heroin, HTN, periorbital edema, oval fat bodies
likely FSGS
46
FSGS
focal and segmental
-polymorphisms in APOL1 gene (blacks)
-C1q nephropathy
HIV, heroin, obesity, UV reflux
47
lymphoma, edema, weight gain, recurrent infections, dyspnea, thickened GBM with spike and dome of subepithelial deposits
membranous GN
48
membranous GN
cause - lymphoma, carcinoma, PCN, gold, SLE, MCTD, thyroiditis, Hep B/C, endocarditis, syphilis
IgG and C3 spike and dome subepithelial deposits
49
PLA2
hereditary membranous GN
50
alpha-1 antithrombin***
gets through the glomerulus
-get clotting
-nephrotic syndrome
51
nephrotic
loss of antithrombin III
protein C
protein S
increased lipoprotein, fibrinogen, and platelet aggregation
52
causes of chronic tubulointerstitial disease**
proud american veterans love GM
prostate
analgesics
VUR
lead
gout
myeloma
53
back pain and increased sed rate
multiple myeloma
54
non-anion gap acidosis**
hyperchloremic acidosis**
55
myeloma
can give you low anion gap
56
RTA type I
distal tubules
-failure of H secretion by alpha intercalated cells
urine pH >5.5 (cannot secrete protons to acidify urine)
basic urine**
57
RTA type II
proximal
-failure of HCO3 reabsorption in prox tub
58
RTA type IV
adrenal
-aldosterone deficiency
get high potassium**
59
multiple myeloma
damage prox tubule
-RTA type II
60
causes of type I RTA**
ampoteracin B
hyper PTH
sjogrens
distal tubule H secretion problems
61
causes of type II RTA**
myeloma protein, tenovofir, toluene, acetazolamide, toperimate, zonisamide
62
Cl/HCO3 relationship
Cl high - bicarb low
>metabolic alkalosis
63
fanconi syndrome
bence jones proteins damaged prox tub and caused to leak HCO3
64