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Flashcards in exam 2 lecture 2 Deck (48):
1

CKD

a spectrum of different pathophysiologic process/diseases associated with abnormal kidney function & a progressive decline in GFR

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hallmark of CKD

decline in GFR

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chronic renal failure

continuing significant irreversible reduction in nephron number, corresponds to CKD stages 3-5

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end stage renal disease (ESRD)

final stage in CKD, accumulation of toxins, fluid & electrolytes results in uremic syndrome. Leads to death unless toxins are removed by dialysis or kidney transplant

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end stage renal disease (ESRD)

final stage in CKD, accumulation of toxins, fluid & electrolytes results in uremic syndrome. Leads to death unless toxins are removed by dialysis or kidney transplant

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stage 0

GFR >90 with risk factors for CKD

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stage 1

GFR >90 w/ kidney damage/malfunction

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stage 2

GFR 60-89

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stage 3

GFR 30-59

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stage 4

GFR 15-29

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stage 5

GFR

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CKD pathophys- initiating mechanisms specific to the underlying etiology

- genetically determined abnormalities in kidney development or integrity
- glomerulonephritis
- tubulointerstitial disease

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DK pathophys 2

response to the progressive reduction of renal mass including hyperfiltration & hypertrophy of the remaining viable nephons

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DK pathophys 2

response to the progressive reduction of renal mass including hyperfiltration & hypertrophy of the remaining viable nephons

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risk factors for CKD

- hypertension
- DM
- autoimmunity (SLE)
- age
- african ancestry
- a family history of renal disease
- previous AKI
- proteinuria, abnormal urinary sediment or structural abnormalities of the urinary tract

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normal GFR

120mL/min

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albuminuria

>17mg albumin/g creatinine is males & 25mg albumin/g creatinine signifies chronic renal damage

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microalbuminuria

refers to the excretion of amounts of albumin too small to detect by regular urinary dipstick. good screening test for early detection of renal disease.
- may be a marker for microvascular disease

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stage 1 & 2 symptoms

- no symptoms related to decreased GFr
- may be symptoms from underlying renal disease
- edema, HTN

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stage 3 & 4 symptoms

- anemia
- easily fatigued
- decreasing apetite & progressive malnutrition
- abnormalities in Ca, P, Vit D, PTH, FGF, Na, K, H2O & acid-base homeostasis

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stage 5 symptoms

- toxins accumulate
->uremic syndrome

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leading etiologies of CKD

- DM glomerular disease
- glomerulonephritis
- HTN nephropathy
- autosomal dominant polycystic kidney disease
- other cystic & tubulointerstitial nephropathy

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pathophys of uremia

1. accumulation of toxins (urea & Cr)
2. loss of renal functions (electrolyte homeostasis & hormone regulation)
3. progressive systemic inflamamation

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clinical abnormalities in uremia

- fluid & electrolyte disturbances
- endocrine-metabolite disturbances (2* hyperPT)
- neuromuscular disturbances
- CV & pulmonary disturbances
- dermatologic - GI
-hematologic & immunologic

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complications & consequences of CKD

- acid/base
- fluids/electrolytes
- CV
- hematologic
- hemostatic
- derm
- endocrine
- GI
-neuromuscular
- Ca, PO & bones

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H+ +HCO3-=

H2O + CO2

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+influences on potassium levels

- dietary intake
- protein catabolism
- GI hemorrhage
- ACEI/ARBs
- transfusion stored erythrocytes
- K-sparing diuretics
- hemolysis

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hyperkalemia occurs more often in

-DM
- diseases affecting distal nephron: obstructive nephropathy & sickle cell

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leading cause of morbidity & mortality in pts at every stage of CKD

cardiovascular disease

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types of ischemic CVD

-occlusive coronary disease
- cerebrovascular disease
- peripheral vascular disease

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ischemic CVD risk factors

- traditional risk factors
- anemia
-hyperphosphatemia
- sleep apnea
- hyperparathyroidism
- generalized inflammation

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CV abnormalities with CKD

-ischemic CVD
- HTN
- left ventricular hypertrophy
- pericarditis
- HF & pulmonary edema

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hematologic abnormalities with CKD

normocytic, normochromic anemia
- stage 3 CKD

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normocytic, normochromic anemia

- insufficient erythropoietin
-iron deficiency
- impaired iron utilization
- severe hyperPTH with bone marrow fibrosis
- shortedned RBC survival in uremic environment

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abnormal hemostasis in CKD

- prolonged bleeding time
- thromboembolism

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bone manifestations of CKD

1. high bone turnover with increased PTH levels (osteitis fibrosa cystica)
2. low bone turnover with low or normal PTH (osteomalacia)

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what regultes Ca homeostasis?

- vit D, PTH & Calcitonin
- also affects PO4

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PTH

- major regulator of Ca
- activates osteoclasts & causes bone resorption which releases Ca

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active Vit D in the kidney is important for

- resorption of Ca & excretion of phosphate

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active vit D in the intestines

causes increased resorption of Ca & PO4

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calcitonin

- opposite of PTH
- stimulates salt deposition of bone
- produced in C cells of thyroid

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secondary hyperparathyroidism is due to

CKD
- reduced GFR
- retention of P
- P stimulates increased PTH
- decreased Ca resulting from diminished calcitriol by the failing liver stimulate PTH
- metabolic acidosis stimulates bone resorption
-start to occur when GFR

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secondary hyperparatyhroidism FGF-23 (phosphatonin)

- promotes renal phosphate excretion
- secreted by osteocytes & increase in CKD
- stimulate PTH which increase P excretion
- suppresses formation of active vit D leading to diminished P absorption from GIT

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high levels of FGF-23

- are also an independent risk factor for left ventricular hypertrophy & mortality in dialysis pts

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renal osteodystrophy

- increased osteoclastic bone resorption- osteitis fibrosa cystica like disease
- osteomalacia (decreased minerals)
- adynamic bone (reduced bone volume & minerals)
- vascular calcification
- growth retardation
- calciphylaxis

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osteitis fibrosa cystica occurs when

PTH is very high

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osteomalacia & adynamic bone can occur when

PTH is low or normal

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osteitis fibrosa cystica symtpms

- bone pain, fragility & fractures
- brown tumors
-compression syndromes
- erythropoietin resistance in part related to bone marrow fibrosis
- PTH related: muscle weakness & heart fibrosis