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Clin Med II > CKD and Nephrotic > Flashcards

CKD and Nephrotic Flashcards

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1
Q

Decreased kidney function OR kidney damage for 3+ months is determined what?

A

Chronic kidney disease (CKD)

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2
Q

What is the hallmark of CKD?

A

Declining GFR (< 60)

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3
Q

What establishes risk for progress and complications of CKD?

A

GFR and albuminuria staging

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4
Q

Pt presents w GFR ≥ 90. What stage of CKD are they?

A

Stage 1

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5
Q

Pt presents w GFR 45-59. What stage of CKD are they?

A

Stage 3a

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6
Q

Pt presents w GFR 30-44. What stage of CKD are they?

A

Stage 3b (refer if GFR <30 to determine cause)

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7
Q

Pt presents w GFR < 15. What stage of CKD are they?

A

Stage 5

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8
Q

Based on a urine albumin-to-creatinine ratio, at what stage should you be concerned for kidney damage?

A

≥ 30 mg/g

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9
Q

The following is the pathogenesis for what kidney disease? Irreversible destruction of nephrons → compensatory hypertrophy → overwork injury → glomerular sclerosis & interstitial fibrosis

A

CKD

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10
Q

The pathogenesis of CKD ultimately leads to abnormal production and metabolism of what 2 things?

A

Erythropoietin and calcitriol

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11
Q

What are the leading causes of kidney failure? (2)

A

DM and HTN

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12
Q

What syndrome is characterized by fatigue, malaise, pericarditis, and encephalopathy?

A

Uremic syndrome

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13
Q

With CKD, HTN → inc PTH → inc phosphorus → acidosis → hyperkalemia ultimately leads to what?

A

Uremic syndrome

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14
Q

What condition involves a spectrum of bone disorders and is clinically detectable at stage 3-4 of CKD?

A

Mineral and bone disorder

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15
Q

In mineral and bone disorder seen with CKD, ↓ GFR, ↑ phosphorus, and ↓ calcium lead to what secondary condition?

A

↑ PTH (secondary parathyroidism)

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16
Q

Infection, urinary tract obstruction, HF (↓ renal perfusion), and nephrotoxic agents might be considered reversible or irreversible causes of CKD?

A

Reversible

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17
Q

On renal US you note small kidneys bilaterally. What should you be concerned for?

A

CKD

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18
Q

What is the tx for CKD? (3)

A
  1. Identify/ tx underlying cause/ reversible factors 2. Slow disease progression 3. Renal Replacement Therapy (RRT) for ESRD
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19
Q

Target BP in CKD pts w/o proteinuria should be what?

A

< 140/90

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20
Q

Target BP in CKD pts w/ proteinuria should be what?

A

< 130/80

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21
Q

What drug classes are used in the treatment of CKD to control BP and have a renoprotective effect and slow proteinuric CKD?

A

ACE-I/ARBs (also should follow a low sodium diet)

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22
Q

When are ACE-I/ARBs contraindicated in the tx of CKD?

A

BIL renal artery stenosis

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23
Q

When are ACE-I/ARBs considered harmful and therefore should not be used in the treatment of CKD?

A

If acute ↓ GFR & hyperkalemia (AKI)

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24
Q

The following are indications for what CKD treatment? Uremic sx Fluid overload to diuresis Refractory hyperkalemia, acidosis, hyperphosphatemia

A

Dialysis

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25
What time of dialysis involves a semipermeable membrane between blood & dialysate?
Hemodialysis
26
What is a complication of hemodialysis?
Hypotension
27
What time of dialysis involves dialysate into peritoneal cavity, with the peritoneal membrane as the dialyzer (used to filter waste)?
Peritoneal
28
What is a complication of peritoneal dialysis?
Peritonitis
29
What is the tx of choice for ESRD?
Kidney transplant
30
Chronic Tubulointerstitial Diseases of the Kidney can all lead to what?
CKD
31
Interstitial scarring and tubular atrophy leading to progressive renal sufficiency is characteristic of what set of conditions?
Chronic Tubulointerstitial Diseases of the Kidney
32
What part of the kidney is spared by Chronic Tubulointerstitial Diseases of the Kidney?
Glomeruli
33
Obstructive uropathy, reflux nephropathy and analgesics are the most common causes of what?
Chronic Tubulointerstitial Diseases of the Kidney
34
Upon exam you note polyuria, hyperkalemia +/- proteinuria and broad waxy casts on urinalysis... what should you be concerned about?
Chronic Tubulointerstitial Diseases of the Kidney
35
What is the treatment for Chronic Tubulointerstitial Diseases of the Kidney? (5)
1. Identify underlying 2. Med management 3. Relief of obstruction 4. Withdrawal of analgesics 5. Refer
36
What condition is characterized by prolonged/recurrent obstruction of urinary tract leading to chronic reduction in GFR and impaired tubular function?
Obstructive Uropathy
37
Pt presents with change in urine output, HTN, hematuria, ↑ serum creatinine, +/- pain and on UA you note hematuria, pyuria, bacteriuria (bland). What condition might you be concerned for?
Obstructive Uropathy
38
What might be seen on US of a pt w/ obstructive uropathy?
Mass, hydroureter, hydronephrosis
39
What condition is the result of vesicoureteral reflux (VUR) or other urologic anomalies of early childhood?
Reflux Nephropathy
40
What condition has the following pathogenesis? Retrograde urine into interstitium → inflammatory response → fibrosis
Reflux Nephropathy
41
Reflux Nephropathy is often dx in young children w/ hx of what?
Recurrent UTIs
42
What 2 diagnostic imaging studies should be performed on a pt with reflux nephropathy?
RUS (scarring & hydronephrosis) VCUG (VUR/lower urinary tract anatomy)
43
Analgesic Nephropathy is defined as CKD due to what?
Long-term analgesic use (Acetaminophen, NSAIDS)
44
What might you see on CT scan of a pt with Analgesic Nephropathy?
Renal papillary necrosis and calcification
45
What is the term for a group of diseases that present primarily w/ proteinuria and bland urine sediment?
Nephrotic spectrum
46
What condition is characterized as noninflammatory damage to glomerular capillary wall?
Nephrotic Syndrome
47
Eval of a pt being evaluated for kidney disease shows the following lab values/ PE... what should you be concerned for? Proteinuria \> 3.5 g/d) Hypoalbuminemia Hyperlipidemia PE: edema, ascites
Nephrotic Syndrome
48
On urine microscopy you note foamy, oval fat bodies. What should you be concerned for?
Nephrotic Syndrome
49
Complications of what condition include hypercoagulability, infection, protein malnutrition, vit. D loss, hypocalcemia and anemia?
Nephrotic Syndrome
50
What is the main tx for Nephrotic Syndrome?
Diuretics/ fluid restriction (also immunosuppressive therapy and nephro referral)
51
What are the 3 primary diseases of the Nephrotic Syndrome?
Minimal change disease (MCD) Membranous nephropathy Focal segmental glomerulosclerosis (FSGS)
52
What is the most common cause of nephrotic syndrome in children?
Minimal change disease (MCD)
53
What primary Nephrotic Syndrome disease often follows a URI and is considered to be a hypersensitivity rxn?
Minimal change disease (MCD)
54
Pt presents with hx of a sudden onset “puffy appearance” and you note podocyte foot process fusion on electron microscopy, what should you be concerned for?
Minimal change disease (MCD)
55
What is 1st line tx for Minimal change disease (MCD)?
Prednisone
56
What is the likely cause of primary membranous nephropathy?
Likely immune-mediated
57
What primary Nephrotic Syndrome has a gradual development and places pts at a higher risk of hypercoagulable state?
Membranous nephropathy
58
Membranous nephropathy is dx with serology or biopsy. How is it treated?
Supportive, +/- immunosuppressive agents, transplant
59
What is one of the most common causes of primary glomerular diseases in adults?
Focal segmental glomerulosclerosis (FSGS)
60
What kidney condition is considered a histologic pattern of kidney injury and NOT a specific disease entity?
Focal segmental glomerulosclerosis (FSGS)
61
What populations are at greater risk for and are likely to have a poorer outcome if dx with focal segmental glomerulosclerosis (FSGS)?
AA's
62
What primary nephrotic syndrome involves glomerular injury resulting from podocyte damage, along with sclerosis in parts of 1+ glomerulus?
Focal segmental glomerulosclerosis (FSGS)
63
What are the primary and secondary causes of Focal segmental glomerulosclerosis (FSGS)?
Primary = idiopathic Secondary = overworked
64
Besides supportive tx, what are the txs for primary and secondary Focal segmental glomerulosclerosis (FSGS)?
Primary = immunosuppressive Secondary = disease-specific tx
65
What are the 2 secondary diseases of the Nephrotic Syndrome?
Diabetic nephropathy Amyloidosis
66
What is the most common cause of ESRD in the U.S.?
Diabetic nephropathy
67
What condition is characterized as structural and functional changes due to HTN with a peak incidence of hyperglycemia seen 10-20 yrs after onset of disease and may also involve retinopathy?
Diabetic nephropathy
68
What is the treatment for diabetic nephropathy? (3)
1. Strict glycemic/ BP control 2. ACE-I/ ARBs, statin therapy 3. Dialysis/ transplant when indicated
69
What disease is characterized as a deposition of amyloids in the glomerulus?
Amyloidosis
70
Are monoclonal light chains indicative of AL amyloidosis or AA amyloidosis?
AL amyloidosis
71
Is chronic inflammatory disease (RA) or infection indicative of AL amyloidosis or AA amyloidosis?
AA amyloidosis
72
What labs should be ordered for a pt with amyloidosis?
SPEP and UPEP
73
What is the treatment for amyloidosis?
Tx underlying cause, refer to nephro

Clin Med II (12 decks)

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