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Clinical Medicine II > Renal: CKD > Flashcards

Renal: CKD Flashcards

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1
Q

MC causes of kidney failure?

A

DM, HTN

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2
Q

GFR < 60 or albumin-Cr ratio (ACR) 30+ indicates…

A

CKD

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3
Q

What stage of CKD?

GFR 90+

A

1

Kidney damage normal GFR

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4
Q

What stage of CKD?

GFR 60-89

A

2

Kidney damage mildly decreased GFR

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5
Q

What stage of CKD?

GFR 45-59

A

3a

mild-moderate decreased GFR

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6
Q

What stage of CKD?

GFR 30-44

A

3b

moderately-severely decreased GFR

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7
Q

What stage of CKD?

GFR 15-29

A

4

severely decreased GFR

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8
Q

What stage of CKD?

GFR < 15

A

5

kidney failure

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9
Q

sxs in CKD may not appear until…

A

advanced

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10
Q

Profound decreased in GFR

fatigue/malaise
pericarditis
encephalopathy/AMS

This indicates…

A

uremic syndrome

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11
Q

What two labs (non serology) are included in workup for CKD?

A

UA

Urine albumin to Cr ratio

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12
Q

What imaging can be helpful for CKD?

A

renal US

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13
Q

What finding on renal US supports CKD?

A

small kidneys bilaterally

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14
Q

CKD is an independent risk factor for…

A

CVD

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15
Q

The following are…

osteitis fibrosis cystica

adynamic bone disease

osteomalacia

A

CKD mineral and bone disorder (CKD-MBD)

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16
Q

What is the typical pattern of CKD-MBD?

A

hyperphosphatemia, hypocalcemia, decreased vitamin D

Leads to Secondary Hyperparathyroidism

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17
Q

When is CKD-MBD detectable

A

stage 3/4

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18
Q

As GFR decreases around 90, rank the 6 complications that begin showing up.

A

HTN, increased PTH, anemia, increased PO4, acidosis/hyperkalemia, uremic syndrome

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19
Q

The following are reversible risk factors for…

infx
obstruction
decreased perfusion
nephrotoxic agents
HF
A

CKD

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20
Q

This class of drugs is:
DOC
-renoprotective, slows progression of proteinuric CKD

decreases albuminuria

A

ACE/ARB

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21
Q

When can ACE-I/ARBs be harmful in CKD?

A

AKI:
can decrease GFR
cause hyperkalemia

Bilateral renal artery stenosis

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22
Q

target BP in proteinuric CKD?

A

< 130/80

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23
Q

when should you consider referral to nephrology with CKD?

A

GFR < 30

or < 60 with severe albuminuria

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24
Q

The following are indications for…

cause CKD

ACR 300+

complication mgmt (EPO, CKD-MBD)

dialysis prep

transplant eval

A

nephrology referral

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25
The following are Indications for what tx in CKD GFR < 30 Uremic Sxs unresponsive fluid overload refractory hyperkalemia, acidosis, hyperphosphatemia
dialysis
26
MC complication of hemodialysis?
hypotension
27
The below conditions represent what diseases of kidney? obstructive uropathy reflux nephropathy analgesic nephropathy
chronic tubulointerstitial diseases
28
This disease refers to kidney disorder that involves the tubules and/or interstitium of kidney, sparing glomeruli
chronic tubulointerstitial disease
29
chronic tubulointerstitial disease is characterized by...
interstitial scarring, tubular atrophy leading to CKD
30
The following are general findings for... - polyuria due to tubular damage - hyperkalemia due to decreased GFR, aldo. resistant DTs - broad waxy casts, proteinuria
Chronic tubulointerstitial diseases
31
This is prolonged/recurrent obstruction of urinary tract with chronic reduction in GFR and impaired tubular fxn...
obstructive uropathy
32
What can be seen on UA for obstructive uropathy?
bland: hematuria pyria bacteria
33
US for obstructive uropathy can be used to detect...
mass, hydroureter, hydronephrosis
34
Which disease is a consequence of vesicoureteral reflux or other childhood anomaly causing fibrosis in interstitium and eventually CKD...
reflux nephropathy
35
Reflux nephropathy is typically diagnosed in what patients?
young children w/ hx of recurrent UTI
36
This type of CKD is caused by: - long term acetaminophen, NSAID use, especially as combo meds (i.e. excedrine) - seen w/ chronic pain, migraines
analgesic nephropathy
37
The following lab results are concerning for what type of CKD/Chronic tubulointerstitial disease? elevated Cr hematuria/sterile pyuria mild proteinuria anemia
analgesic nphropathy
38
CT scan in analgesic nephropathy would show...
renal papillary necrosis and calcification
39
How do you treat chronic tubulointerstitial disorders?
ID underlying cause relieve obstruction withdrawal of analgesics referral
40
This is noninflammatory damage to glomerular capillary wall. ``` proteinuria > 3.5 hypoalbuminemia edema hyperlipidemia foamy urine oval fat bodies ```
Nephrotic syndrome
41
Three primary causes of nephrotic syndrome...
minimal change disease membranous nephropathy focal segmental glomerulosclerosis
42
The following are sxs of what syndrome? ``` malaise anorexia dyspnea abd. distension weight gain ortho hypotension ```
nephrotic syndrome
43
two main complications of nephrotic syndrome...
hyper-coagulability | Infection
44
What about nephrotic syndrome that can lead to hypercoabulability?
urine loss antithrombin, proteins C/S increased platelet activation
45
Infection is common in nephrotic syndrome due to...
urinary loss of immunoglobulins defects in complement cascade
46
This is the most common cause of nephrotic syndrome in children, and is mostly idiopathic. It can also be preceded by URI, hypersensitivity,
minimal change disease
47
Describe the onset of sxs in minimal change disease...
rapid over days-weeks
48
Minimal change disease primarily effects what part of the nephron?
podocyte diffuse podocyte foot process fusion
49
What is first line for MCD?
prednisone
50
does MCD progress to ESRD?
not usually
51
This disease has the following characteristics: - peaks 4th/5th decades - common form of nephrotic syndrome in adult population
membranous nephropathy
52
Primary membranous nephropathy is thourght to be...
immune mediated
53
The following diseases can cause... ``` HBV autoimmune disease thyroiditis malignancy drugs ```
secondary MN
54
describe the onset of nephrotic syndrome in membranous nephropathy...
gradual
55
membranous nephropathy makes you at higher risk of...
hypercoagulability (renal vein thrombosis)
56
How do you treat MN?
supportive care +/- immunosuppression/transplant
57
This is a common cause of primary glomerular disease. It represents a histologic pattern of kidney injury Presentation is nephrotic syndrome Black patients are at greater risk...
focal segmental glomerulosclerosis (FSGS)
58
this disease: - glomerular injury via damaged podocytes - sclerosis in parts of at least one glomerulus
FSGS
59
Primary FSGS is caused by...
idiopathic
60
Obesity, infx, inflammation, toxin, previous glomerular injury, reflex nephropathy, HTN can be causes of...
secondary FSGS
61
How is primary FSGS treated?
immunosuppressive agents
62
Secondary FSGS is treated with...
disease specific treatment
63
What factors contribute to a poor prognosis for FSGS?
nephrotic range proteinuria black renal insufficiency
64
this is the most common cause of ESRD defined by structural and functional changes. It commonly occurs with retinopathy...
diabetic nephropathy
65
4 treatment options for diabetic nephropathy...
glycemic/BP control ACE/ARBs Statin Dialysis/transplant
66
AL amyloidosis is characterized by the presence of...
monoclonal light chains
67
AA amyloidosis is characterized by...
chronic inflammatory dz/infx
68
What tests can screen for renal amyloidosis
SPEP/UPEP
69
tx for renal amyloidosis?
refer
70
what is an early sign of diabetic nephropathy?
albuminuria

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