Renal 2 (Week 13)

Question 1

What causes prerenal AKI

Answer 1

reduced blood perfusion of kidney

Question 2

what causes reduced blood perfusion to kidneys

Answer 2

arterial hypotension
dehydration
sepsis
arterial occlusion (plaques, air bubbles, fat globules)
administration of ACE inhibitors or ARB meds

Question 3

what do NSAIDs do

Answer 3

inhibit production of all types of prostaglandins

Question 4

intrinsic AKI

Answer 4

damage to structures within the kidney

Question 5

most common cause of intrinsic AKI

Answer 5

acute tubular necrosis

Question 6

what causes acute tubular necrosis

Answer 6

renal ischemia

shock syndrome

Question 7

causes of intrinsic AKI

Answer 7

acute tubular necrosis
exposure to toxins such as
-myoglobin
-contrast dyes
-aminoglycosides
-infections (TSS)
- auroimmunity
-other pharmaceuticals

Question 8

postrenal AKI due to

Answer 8

obstruction of flow in urinary system

Question 9

causes of postrenal AKI

Answer 9

prosttatic hypertrophy or cancer
infection
improperly placed urinary catheter
nephrolithiasis (kidney stone)

Question 10

primary means to determine presence of AKI

Answer 10

serum creatinine

urine output

Question 11

other tests used to detect AKI

Answer 11

urine sedimentation
urine osmolality and electrolytes
serum electrolytes
urinary specific gravity
microscopic eval of urine
blood urea nitrogen

Question 12

what would you look for in microscopic eval of urine

Answer 12

bacteria
pieces of dead cells
-indicates infection or breakdown of cells (usually renal tubular cells)

Question 13

blood urea nitrogen more useful for

Answer 13

monitoring chronic kidney disease

Question 14

what happens as BUN levels increase above normal?

Answer 14

GFR decreases below normal

Question 15

albuminuria

Answer 15

albumin (protein) in urine

Question 16

how is chronic kidney disease defined (CKD)

Answer 16

abnormalities in kidney structure or function present for 3 months or longer

Question 17

structural abnormalities seen in chronic kidney disease

Answer 17

albumuria
hemaaturia
presence of red cell casts
electrolyte abnormalities

Question 18

what indicates a functional abnormality in CKD

Answer 18

drop in GFR

Question 19

Biggest risk factor for CKD

Answer 19

diabetes

Question 20

other risk factors for CKD

Answer 20

hypertension

60 y/o or greater

Question 21

prognosis of CKD determined by

Answer 21

• cause of kidney disease
• GFR at diagnosis
• degree of albuminuria
• presence of other pathologies

Question 22

what cause of kidney disease would yield a poor prognosis

Answer 22

autoimmune process

Question 23

(increased/decreased) GFR at diagnosis yields a poor prognosis in CKD

Answer 23

decreased

Question 24

(increased/decreased) albuminuria yields a poor prognosis in CKD

Answer 24

increased

Question 25

what comorbid pathologies would yield a poor prognosis in CKD

Answer 25

diabetes high BP pulmonary disease autoimmune disorders

Question 26

what does KDOQI stand for

Answer 26

Kidney Disease Outcome Quality Initiative

Question 27

what does the KDOQI categorize

Answer 27

categorizes CKD into categories based on GFR

Question 28

(higher/lower) KDOQI level indicates worse prognosis

Answer 28

higher

Question 29

how is hypertension related to CKD

Answer 29

- can cause or be a result of CKD - retaining water and sodium - derangements of angiotensin system

Question 30

what does proteinuria have a direct proportion to?

Answer 30

risk of cardiovascular disease

Question 31

nicotine causes vaso(constriction/dilation)

Answer 31

vasoconstriction

Question 32

what does smoking do in relation to CKD

Answer 32

reduces GFR increases BP increases urinary albumin excretion

Question 33

what does cigarette pack years help predict

Answer 33

how fast CKD will progress

Question 34

hos is pack years calculated

Answer 34

packs per day x # years smoker

Question 35

what is the relationship between smoking and CKD

Answer 35

obesity increases risk of G5 CKD

Question 36

what does CKD progress into after several years

Answer 36

end stage renal disease

Question 37

what type of tx are patients typically undergoing at ESRD

Answer 37

dialysis (or being considered)

Question 38

what causes CKD to progress into ESRD

Answer 38

- ongoing loss of nephron mass - glomerular capillary hypertension - proteinuria

Question 39

what happens with glomerular capillary hypertension

Answer 39

hypertrophy of remaining glomeruli; pores get larger; more protein goes through pores leading to proteinuria

Question 40

what does erythropoietin do

Answer 40

secreted by kidney; acts on marrow to produce RBC

Question 41

how is CKD related to anemia

Answer 41

decreased production and secretion of erythropoietin occurs due to damage and loss within kidney

Question 42

what stage of CKD is anemia typically present

Answer 42

C3a and beyond

Question 43

how is CKD related to osteoporosis

Answer 43

decreased elimination of phosphorus which leads to hyperphosphatemia and a decrease in calcium levels. decreased conversion of vitamin D into its active form so less calcium absorption in gut

Question 44

what happens in CKD in relation to acid base balance

Answer 44

CKD interferes with acid-base balance; CKD patients are acidotic

Question 45

medical treatment for CKD

Answer 45

control acid/base balance control electrolyte imbalances antihypertensive medications (ACE inhibitors, ARBs)

Question 46

how are electrolyte imbalances controlled in CKD

Answer 46

dietary restriction | -limit potassium, sodium, or water intake

Question 47

Therapeutic treatment of CKD

Answer 47

diet- protein restriction, sodium restriction (elevated sodium increases BP and proteinuria) exercise- achieve and maintain healthy BMI smoking cessation- slows progression of CKD pharmaceuticals- diuretics; treat sx/problems