Chronic Renal Failure CIS Flashcards Preview

RENAL II Exam 3 > Chronic Renal Failure CIS > Flashcards

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

9

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

28

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

myeloma kidney

high Ca
high uric
amyloidosis
B cell infiltrates
hyperviscosity