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Pathophysiology I > Pathophysiology: Chronic Kidney Disease > Flashcards

Pathophysiology: Chronic Kidney Disease Flashcards

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1
Q

Functions of the kidney

A
  • Excretory
  • Endocrine/Metabolic
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2
Q

Excretory function of the kidney

A
  • blood is filtered through glomerulus -> tubules fine tune solutes -> urine output
  • homeostasis of: water, electrolytes, acid-base, toxins
  • via: filtration (passive), secretion (active), reabsorption
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3
Q

Endocrine/metabolic function of kidney

A
  • renin production
  • erythropoetin production
  • vitamin D activation
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4
Q

Chronic Kidney Disease (CKD)

A
  • abnormalities of kidney structure or function
  • must be present for more than 3 months!
  • classified based on cause, GFR category, and albuminuria category (CGA)
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5
Q

CKD Workup

A
  • Urinalysis
  • Labs: CMP
  • Biopsy
  • US, CT, nuclear flow scan
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6
Q

What percentage of kidney loss to get to late stage CKD?

A
  • 90% kidney function
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7
Q

CKD Prevalence

A
  • More than 1 out of 10 adults has some level of CKD
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8
Q

Primary cause of ESRD

A
  • Diabetes Mellitus (49%) and Hypertension (28%)
  • pts in hemodialysis are the most common
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9
Q

ESRD incidence and prevalence in CKD

A
  • more pts going on dialysis and CKD as time goes on
  • pts with CKD have a higher mortality
  • heart disease is the number 1 disease in the US
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10
Q

What is used for staging CKD?

A
  • Modification for Diet in Renal Disease (MDRD)
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11
Q

Modification for Diet in Renal Disease (MDRD)

A
  • estimates GFR
  • preferred for staging CKD
  • more accurate than Cockcroft-Gault when staging CKD
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12
Q

Cockcroft-Gault Equation

A
  • estimates Creatinine Clearance
  • preferred for drug dosing in CKD
  • no longer used for staging CKD
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13
Q

CKD Epidemiology Study group (CKD-EPI)

A
  • also estimates eGFR
  • more accurate in pts with GFR >60mL/min/1.73m²
  • is the preferred formula since there is no race variable
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14
Q

Stage 3 CKD

A
  • is subdivided to 3a and 3b
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15
Q

What is the relationship between GFR and the staging of CKD?

A
  • depending on how low the GFR is, the higher or worse the staging for CKD is
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16
Q

Which stage of CKD do symptoms start?

A
  • Stage 3 CKD
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17
Q

Stage 1 and Stage 2 CKD

A
  • asymptomatic
  • best time for preventative care
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18
Q

Stage 5 CKD

A
  • when pts are on dialysis
  • almost all pts have NO urine output
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19
Q

CKD Staging: Albuminuria

A
  • aka proteinuria
  • 24-hour urine collection
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20
Q

“Spot” urine sample

A
  • Albumin-to-Creatinine Ratio (ACR)
  • most accurate way to measure albumin
  • often provided with laboratory test results
  • used as an estimate
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21
Q

Urine dipstick

A
  • NOT reliable
  • done in 5 minutes
  • Yes or No if you have proteinuria
  • does NOT quantify AER or ACR
  • NOT used
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22
Q

Stage A1: Albuminuria

A
  • AER: <30 mg
  • ACR: <30 mg/g
  • Normal to mildly
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23
Q

Stage A2: Albuminuria

A
  • AER: 30-300 mg
  • ACR: 30-300 mg/g
  • Description: Moderately
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24
Q

Stage A3: Albuminuria

A
  • AER: >300 mg
  • ACR: >300 mg/g
  • Description: Severely
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25
Why do we need to stage someone with CKD?
- the worst staging of CKD and higher A3 means the higher the proteinuria - so we can keep track overtime
26
Efferent arteriole
- blood flow outward
27
Afferent arteriole
- blood flow inward
28
The loss of nephron mass results in?
- changes in the efferent and afferent side which changes the surface area - reduced GFR - compensatory hypertrophy
29
Key elements of CKD
1) Loss of nephron mass 2) Glomerular capillary hypertension 3) Proteinuria 4) Progressive nephron loss
30
Glomerular capillary hypertension
- mediated by angiotensin II - increased filtration fraction - altered membrane permeability
31
Proteinuria
- promotes inflammatory and vasoactive cytokines and complement - direct tubular toxicity
32
Progressive nephron loss
- Glomerulosclerosis - Interstitial fibrosis - Reduced GFR
33
What is not a risk factor for CKD?
- alcohol use
34
CKD Risk factors: Susceptibility to CKD
- advanced age - reduced kidney mass - low birth weight - racial/ethnic minority - family history - low income or education - systemic inflammation - previous acute kidney injury - exposure to certain drugs or chemicals
35
CKD risk factors: progression of CKD
- Diabetes - Hypertension - Proteinuria - Obesity (BMI: equal or more than 30) - smoking - Dyslipidemia
36
What is the number one leading cause of CKD?
- Diabetes
37
Diabetes Mellitus 1 (DM1):
- 80% will develop overt nephropathy
38
Diabetes Mellitus 2 (DM2)
- 20-40% will progress to CKD
39
Diabetes MOA in CKD
- risk increases with mean glucose (A1C) and proteinuria - Mechanism: hyperglycemia -> mesangial expansion, glomerular basement membrane thickening, podocytopathy, impaired filtration/proteinuria
40
Hypertension in CKD
- #2 leading cause of CKD - result of CKD (fluid overload) - risk of CKD increase with BP and proteinuria - Mechanism: increased intraglomerular pressure -> glomerular injury -> impaired filtration/proteinuria
41
Cause of Kidney disease with chronic use of:
- NSAIDs - Salicylates - Lithium - Calcineurin inhibitors
42
Clinical Manifestation of CKD
- Fluid and Electrolyte Disturbances - Acid-base disturbances - Osteodystrophy - Calcium Homeostasis - Mineral and Bone disorder - Calcium, Phosphorus & the Cardiovascular System - Calciphylaxis (uremic arteriolopathy) - Cardiovascular abnormalities - Anemia of CKD - Other
43
Impaired tubular excretion of Na+
- results in extracellular fluid volume expansion - influenced by dietary sodium intake - hypertension, peripheral and pleural edema, weight gain
44
Impaired reabsorption of Na+ (when needed for extrarenal fluid losses)
- prone to ECFV depletion - acute-on-chronic kidney failure
45
Impaired tubular excretion of K+
- hyperkalemia - risk for life threatening arrythmias - influenced by diet, drugs, transfusion, hemolysis and acidosis
46
Impaired tubular excretion of Mag++
- mild hypermagnesemia
47
Impaired tubular excretion of [PO4-]
- contributes to development of mineral-bone-disorder and hyperparathyroidism
48
Acid-Base disturbances
- decreased GFR leads to retention of organic acids - hyperkalemia decreases ammonia production, reducing urinary buffer and bicarbonate regeneration = Anion-gap metabolic acidosis = Protein catabolism
49
How is Ca++ maintained?
-by Calcitonin and PTH - needs to maintain [Ca++] 10mg/100mL
50
What happens when there is too much Ca++?
- will trigger calcitonin secretion
51
Calcitonin role in the bone
- will continue to produce until [Ca++] levels are in homeostasis
52
PTH role in calcium homeostasis
- tells kidneys to activate Vitamin D - stimulate Ca++ release from bones - increase Ca++ uptake in the intestines
53
Overtime, the release of PTH
- will cause increase Ca++ mobilization from the bone - increase renal Ca++ reabsorption - decrease phosphate
54
What occurs in the later stages of CKD?
- secondary hyperparathyroidism = hypocalcemia - the result of another condition that lowers the blood calcium, which then affects the gland's function - result in kidney failure and Vit D deficiency
55
Progressive kidney disease leads to
- decrease phosphate excretion = hypocalcemia - decrease Calcitriol (Vitamin D3) production = hypocalcemia - increased PTH
56
What happens when there is decreased phosphate excretion?
- there will be phosphate retention which can lead to hypocalcemia - OR increased calcium phosphate crystals which leads to Soft Tissue Calcification
57
increased PTH
- is caused by hypocalcemia - which leads to: 1) increased Ca++ mobilization from bone 2) increased renal Ca++ reabsorption 3) decreased renal phosphate reabsorption
58
Decreased Calcitriol
- decreased GI Ca++ absorption = Hypocalcemia or impaired bone mineralization
59
impaired bone mineralization
- Osteomalacia
60
Calciphylaxis
- blood vessel occlusions with extreme vascular and soft tissue calcification: skin necrosis and poor wound healing - associated with Warfarin therapy and calcium-based phosphorus binders - very poor prognostic factor - stops blood flow altogether
61
Anemia of CKD
- low hemoglobin - reduce transport of blood oxygen - decreased erythropoietin - Folate(B9) and/or Cobalamin (B12) deficiencies - pernicious anemia - iron deficiency - megaloblastic anemia
62
Other clinical manifestation of CKD
- uremic bleeding (platelet dysfunction) - reduced insulin elimination - reduced estrogen, testosterone - dry, itchy skin
63
Decreased levels of ____ is the cause of this anemia. a) Erythropoietin b) Iron c) PTH d) Vitamin D
Erythropoietin
64
______ levels of _______ would cause bone disease in CKD. a) increased; calcitonin b) decreased; calcitonin c) increased; PTH d) decreased; PTH
increased; PTH

Pathophysiology I (4 decks)

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