Week 3 Flashcards
(135 cards)
1
Q
creatinine
A
waste from muscle metabolism
2
Q
GFR
A
glomerular filtration rate; estimates how much blood passes through glomeruli each minute
3
Q
normal GFR
A
> 60
4
Q
proteinuria
A
protein presence in urine
5
Q
hematuria
A
blood in urine
6
Q
not graded AKI defined as ___
A
increased serum creatinine
- > 0.3 mg/dl (>26.5 micromol) within 48 hrs
- 1.5x baseline occurred within 7 days
urine volume < 0.5ml/kg/h for 6 hrs
7
Q
non-oliguric AKI
A
> 400 ml daily
8
Q
oliguria
A
< 400 ml daily
9
Q
anuria
A
< 100 ml daily
10
Q
etiology of vasculitis
A
small vessel disease
11
Q
etiology of glomerulonephritis
A
glomerular disease
12
Q
etiology of acute tubular necrosis
A
toxins / ischemia
13
Q
pre-renal pathophysiology phases
A
1) initiation (ischemia)
2) extension (corticomedullary junction hypoxia)
3) maintenance
4) recovery
14
Q
what happens during initiation of pre-renal pathophysiology phases
A
tubular obstruction, exfoliation, BBM Loss
15
Q
what happens during extension of pre-renal pathophysiology phases
A
obstruction, coagulopathy, microvascular injury inflammation,
16
Q
what happens during maintenance of pre-renal pathophysiology phases
A
dedifferentiation, migration, proliferation
17
Q
what happens during recovery of pre-renal pathophysiology phases
A
redifferentiation & repolarization
18
Q
ionizing radiation causes ___ at renal blood vessels
A
renal injury & function loss
19
Q
effects of radiation therapy on renal injury
A
radiation disrupts chemical bonds & knocks e- out of atom; ROS created leading to DNA damage & death
20
Q
effects of radionuclide therapy on renal injury
A
radioisotope protein conjugate filtered at glomeruli and reabsorbed by tubular epithelium, radioemitter lodged in kidney leading to renal injury
21
Q
what is the acceptable threshold of photon irradiation that can cause radiation nephropathy
A
both kidneys irradiated total dose of 23G and fractionated in 20 doses over 4 weeks
22
Q
CKD will not occur from irradiation if total irradiated renal volume is ___
A
<30% of both kidneys
23
Q
renal failure from radiation nephropathy will not occur if ___
A
only 1 kidney irradiated with threshold/higher dose
24
Q
what is done prior to stem cell transplant
A
chemo-irradiation conditioning
25
___ potentiates radiation effects
preceding / concurrent chemotherapy
26
patient related factors for radiation nephropathy
2C3D
- CKD
- concomitant nephrotoxins
- DM
- decreased IV volume
- decreased CO
27
procedure related factors for radiation nephropathy
- increased radiocontrast dose
- intra-arterial administration
- hyperosmolar radiocontrast
- many procedures within 72 hrs
28
renal failure evaluation
history = family, drug, past, complications
physical exam = fluid status, uraemia, kidney ballot, renal bruit, distended bladder
investigation = blood, urine, imaging, renal biopsy
29
kidney function includes
regulating RBC, BP, bone mineral metabolism, blood pH, excretion
30
drugs used to counter renal hemodynamic changes
atrasentan, ruboxistaurin, sulodexide, baricitinib
31
drugs used to counter ischemia & inflammation
bardoxolore methyl, pyridoxamine, pirfenidone, PTF
32
drugs used to counter overactive RAAS
finerenone, vitamin D, PTF
33
pxt with anemia have reduced RBC lifespan of __
60 - 90 days
34
anemia treated using
SCr EPO, iron supplement
35
presence of uraemic toxins lead to __
platelet dysfunction & increased bleeding
36
what happens in kidneys during lactic acidosis
kidneys cannot produce ammonia in proximal tubules to excrete endogenous acid into urine in ammonium form
37
lactic acidosis causes __
increased bone + muscle loss & CKD progression
38
high BP treated using
- low salt diet
- beta blockers
- Ca2+ channel blockers
- diuretics
- ACEi / ARB
39
ACEi
angiotensin converting enzyme inhibitors
40
ARB
angiotensin II receptor blockers
41
how does decreased GFR lead to increased bone loss
decreased GFR = decreased vitamin D + increased PO43-, FGF-23 = decreased Ca2+ & increased PTH = bone loss
42
PTH
parathyroid hormone
43
leading factors of CVS which is the leading cause of death in CKD pxt
smoking, obesity, diabetes, hypertension, lipids
44
how to treat pruritus (itchy skin)
UV therapy, Gabapentin, Anti-histamines, suu balm
45
how to treat nausea
metoclopramide
46
how to treat appetite loss
supplements
47
how to treat AKI / CKD pxt
low salt, K+, PO43- diet
48
hyperkalaemia
low K+ excretion
49
hyperphosphataemia
low PO43- excretion
50
hypocalcaemia
decreased Ca2+ absorption due to decreased plasma calcitrol, increased Ca2+ & PO43- binding leads to increased SCr
51
low Na+ & H2O excretion leads to ___
increased extracellular volume expansion
52
how to treat fluid overload
diuretics, fluid restriction, low salt diet
53
semi-permeable membrane for dialysis
peritoneal dialysis + hemodialysis
54
peritoneal dialysis inserted into
abdomen
55
peritoneal dialysis exchange timing
30 mins (10 mins inflow, 20 mins outflow)
56
peritoneal dialysis benefits
can be done anywhere daily = less strict diet and painless
57
continuous ambulatory peritoneal dialysis
3 - 4x daily, PD solution remains in abdomen 4-6hrs, kept dry overnight / night dwell
58
automated peritoneal dialysis
cycler used as pxt sleeps 8 - 10 hrs
- continuous cycling PD w/ day dwell
- nocturnal intermittant PD w/ day dry
59
peritoneal dialysis infective complications
PD peritonitis, exit site infection, tunnel infection
60
peritoneal dialysis non-infective complications
mechanical
- hernia, leaks, abdominal pain, catheter obstructions
metabolic
membrane complications
61
hemodialysis
3x / week for 4hrs per session
62
hemodialysis uses 2 needles which are for
removing blood & returning cleansed blood
63
hemodialysis access channels
1) vascular catheter
2) arteriovenous fistula
3) arteriovenous graft
64
hemodialysis vascular catheter includes
tunneled & temporarily non-tunneled
65
hemodialysis arteriovenous fistula includes
radiocephalic, brachiocephalic, brachiobasilic
66
hemodialysis arteriovenous graft includes
loop & small
67
hemodialysis complications
infections, thrombus, stenosis, occlusions (kink, fibrinsheath, blood clot)
68
intermittent hemodialysis
3x / week for 4hrs per session
69
nocturnal hemodialysis
3x / week for 6-8 hrs per session
70
intradialytic complications
ABCD DMH
- air embolism
- BP
- cardiac arrhythmia
- dialysis disequilibrium syndrome
- dialyser reaction
- hemolysis
- muscle cramps
71
what is an independent predictor of ESRD pxt
VO2 peak
72
CVS activity recommended for ESRD
30 mins x 5 / week
73
high Vd =
low protein binding, high tissue binding
74
drug dosing is adjusted to __
GFR; maintained using lower doses & more intervals
75
drug dosing includes
diuretics, antimicrobials, oral hypoglycaemic agents, analgesics
76
dialysate resembles __
electrolytes of human blood
77
contrast induced nephropathy is ___
reversible AKI after radiocontrast media administration with renal function decline 48 - 72 hrs after IV, SCr peaks at 3-5 days
78
latent period of acute radiation nephropathy
6-12 months
79
latent period of chronic radiation nephropathy
> 18 months
80
latent period of malignant hypertension
12 - 18 months
81
latent period of benign hypertension
> 18 months
82
radiated nephropathy occurs as a late phenomenon due to
decreased renal cell turnover rate & delayed expression of renal injury post radiation
83
steps that occur in nephron
filtration, reabsorption, secretion, excretion
84
CKD
abnormal kidney structure / renal function for > 3months
85
administration of ___ remains an uncertain benefit for eGFR
N-acetylcysteine & intravenous sodium bicarbonate
86
loss of nephrons triggers what system
renin angiotensin aldosterone system
87
medications for glomerular hypertrophy & sclerosis
ruboxistaurin
sulodexide
baricitinib
88
medications for tubulointerstitial fibrosis & tubular atrophy
pirfenidone & PTF
89
PTF used for
tubulointerstitial fibrosis & tubular atrophy & mesangial cell expansion
90
high phosphate levels prevented by
restrict high phosphate foods, PO43- binders, dialysis
91
high PTH levels prevented by
parathyroidectomy
92
common complication in ckd
malnutrition
93
conservative management of CKD
kidney transplant, peritoneal dialysis, hemodialysis
94
donor after cardiac death
death must be due to CVS reasons rather than neurological
95
expanded criteria deceased donor includes
> 60 years old
OR 50 - 59 years old w/
- terminal Cr >1.5mg/dl
- death due to CVA
- hypertension
DM of any age
96
difference between diffusion, ultrafiltration, osmosis
diffusion = solution moves by concentration gradient
osmosis = water moves by concentration gradient
ultrafiltration = solution moves by pressure gradient
97
peritoneal dialysis non-infective metabolic complications
hyperglycemic, insulin resistant, weight gain, dyslipidaemia
98
peritoneal dialysis non-infective mechanical complications
hernias, leaks, catheter obstrction, abdominal pain
99
peritoneal dialysis non-infective membrane complications
encapsulating peritoneal sclerosis, membrane failure
100
types of hernias
- inguinal / femoral
- ventral
- umbilical
- paraumbilical
101
peritoneal equilibrium test initiated __
4-8 weeks after initiation
102
peritoneal equilibrium test analyses ___
urea, creatine & glucose
103
why is glucose used as a solvent in peritoneal dialysis
cheap, safe & effective, proven to work for 2 decades
104
if severe heart failure, should u use PD or HD
PD first
105
low vitamin D countered using
calcitriol
106
high phosphate level countered by using
phosphate binders, decrease phosphates, dialysis
107
high PTH countered by using
parathyroidectomy
108
catether obstructions lead to
constipation, kink, fibrin, omentum wrapping, tip migration
109
vasopressin / adh promotes
h2o resorption
110
aldosterone promotes
Na+ resorption
111
atrial natriuretic peptide regulates
Na+ & K+
112
mechanical causes of edema
increased capillary hydrostatic pressure, and capillary permeability
decreased plasma osmotic pressure & lymphatic function
113
causes of fluid dehydration
vomit / diarrhea
sweating
diabetic ketoacidosis
insufficient fluid intake
114
primary cation in extracellular fluid
sodium
115
Na+ mainly controlled by
kidney via aldosterone
116
Na+ used in
muscle contraction, nerve conduction, maintaining extracellular fluid
117
K+ main cation in
intracellular fluid
118
K+ influenced by
aldosterone, insulin, acid-base balance
119
Ca2+ controlled by
PTH, calcitonin, Vitamin D, phosphate levels, acid-base balance
120
urine filtration occurs in
bowman capsule
121
urine resorption occurs in
loop of henle, proximal and distal convoluted tubules
122
urine resorption controlled by
ADH, aldosterone, atrial natriuretic hormone
123
blood tests for acute renal failure
elevated serum urea nitrogen & creatinine test
metabolic ketoacidosis
hyperkalemia
124
chronic renal failure key indicators
azotemia, anemia, acidosis
125
CKD levels
1 = 90 - 120
2 = 60 - 89
3 = 30 - 59
4 = 16 - 29
5 < 15
126
3 types of renal management
thiazide, loop diuretics, K+ sparring
127
thiazide targets
distal tubules for hypertension
128
loop diuretics targets
loop of henle for fluid retention, heart failure, kidney disease
129
K+ sparring targets
collecting tubules for heart, kidney and liver disease
130
side effects of diuretics
dizzy, excessive electrolyte loss, hyponatremia, hypokalemia
131
contra-indications for diuretics
anti-depressants, cyclosporine, digitalis, insulin
132
contra-indications of antidepressants
thiazide & loop acting diuretics
133
contra-indications of cyclosporine
K+ sparring
134
contra-indications of digitalis
decreased K+ pxt
135
contra-indications of insulin
thiazide & loop acting diuretics
