Flashcards in Session 11 - Chronic Kidney Disease Deck (60)
Define chronic kidney failure
• The progressive and irreversible loss of renal function over a period of months to years
What is the underlying pathology of chronic kidney failure?
• Function renal tissue is replaced by extra-cellular matrix, which gives rise to glomerulosclerosis and tubular intersitial fibrosis
What does a diseased kidney do?
What does chronic kidney failure result in?
• Progressive loss of both the excretory and hormone functions of the kidney
• Proteinuria and systemic hypertension develops
Give 8 causes of chronic kidney disease
I gave GOD HIV
○ Polycystic Kidney Disease (PCK)
○ Alport’s Syndrome
• Obstruction and reflux nephropathy
• Systemic Disease
• Cause unknown
What are the three most common causes of chronic kidney disease
• Diabetes mellitus
What do most patients with CKD have?
• Ischaemic Heart Disease
What is polycystic kidney disease?
• Multiple cysts appear on the kidney
What is Alport syndrome?
• Hereditary nephritis caused by an x-linked mutation
• Proliferating and sclerosing kidney disease
How is Chronic Kidney Disease classified?
• By amount of GFR fall and kidney disease
How many stages of chronic kidney disease are there?
What is stage 1 of chronic kidney disease? GFR, description, clinical diagnosis, %population
• >90 GFR
• Kidney damage with normal or increased GFR
• Need other evidence of kidney damage
What is stage 2 of chronic kidney disease? GFR, description, clinical diagnosis, %population
• 60-89% GFR
• Kidney damage with mild GFR fall
• Need other evidence of kidney dmage
• 3% population
What is stage 3 of chronic kidney disease? GFR, description, clinical diagnosis, %population
• 30-59% fall in GFR
• Moderate fall in GFR
• Symptoms +/-
What is stage 4 kidney disease?
• Severe fall in GFR
• Symptoms ++
• 0.2% population
What is stage 5 kidney disease
• <10ml/min GFR
• 0.1% population
What is the incidence of CKD?
• 85% have diabetes, hypertension or ischaemic heart disease
• More common in the elderly, ethnic minorities and the socially disadvantaged
Why don't most patients with CKD end up needing dialysis?
High cardiovascular mortality at all stages of CKD
Give four systems affected by CKF
What does CKF cause in the CVS system?
What does CKF cause in haemotologically
○ Decreased erythropoietin
○ Resistance to erythropoietin
○ Decreased RBC survival
Where is erythropoietin produced?
The interstitial fibroblasts in the kidney, in close assocaiation with peritublar capillaries.
What does CKF cause in the bone?
• Renal bone disease
Give two forms of renal bone disease
• Decreased GFR means less phosphate is excreted, increasing serum conc. Then forms complexes with free Ca2+, reducing effective serum conc. Stimulated PTH release, causing overactivity of osteoclasts - Osteitis Fibrosa Cystica
• Less Vitamin D hydroxylated to Calcitriol, causing hyperparathyroidism and osteomalacia
Where does hydroxylation of vitamin D occur?
• First step in the liver - prohormone calcifedol
Second step in the kidney
Give three CNS symptoms of CKD
Give three general symptoms of CKD?
How likely is a patient to require dialysis compared to their changes of having a CVS event?
• More likely to have CVS event than to require dialysis
What is a normal range of GFR?
• 80-120 ml/min