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Pathophysiology > Exam 3: Renal CKD and Stones > Flashcards

Exam 3: Renal CKD and Stones Flashcards

1
Q

Chronic Kidney Disease:

Disease that progresses ______

Takes months to years to develop

A

Chronic Kidney Disease:

Is a disease that progresses slowly overtime

months to years to develop

CKD is defined as GFR < 60 for three months irrespective of cause

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2
Q

CKD Stages

Explan the following stages of CKD depending on GFR
1. Normal > 90

  1. Due to age 60-89

3A

3B

4

5.

A
  1. Normal GFR > 90
  2. Due to age GFR: 60-89

3A. Minimal Risk: 45-59

3B Increased CV Risk: 30-44

  1. Increased risk of ESRD: 15-29
  2. Requires renal replacement therapy < 15
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3
Q

Nowadays, clinicians are suggested not to only measure GFR when evaluating the stage of a patient’s CKD, but also include _____

What combo is bad?

A

GFR and albumin are looked at

Low GFR and high urine albumin are BAD

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4
Q

Most common cause of CKD?

A

Most common cause of CKD is diabetes

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5
Q

Analgesic Nephropathy:
CKD due to use of _____ meds

Presentation: ____, _____, _____, ____

Caused by what mechanism?

How to treat analgesic nephropathy?

A

Analgesic Nephropathy:

CKD due to use of NSAIDs

Presentation: anemia, HTN, headaches, pyuria (WBCs in urine)

Caused by renal papillae necrosis- scarring of capillaries

Treat by discontinuing NSAID use

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6
Q

Explain other causes of CKD

Most common is ____

Second leading cause is _____

Glomerular disease - immune mediated

Genetic diseases: example is ______
Kidney obstruction

Medications, acute kidney injury (if ____)

A

Other causes of CKDL

  • main: diabetes
  • Second leading cause: hypertension
  • Glomerular disease: immune mediated
  • Genetic Disease: polycystic kidney disease (leading genetic cause of CKD, large sac filled things on kidneys only treatment is transplant or dialysis)
  • Kidney obstruction
  • Medications, acute kidney injury if left untreated
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7
Q

One of the first outcomes of CKD is volume overload:

What is the cause of volume overload due to CKD?

What are the symptoms?

A

Volume overload is one of the first concequences of CKD

Causes of volume overload: decreased functional nephrons, decreased ability to excrete salt, high salt diets make it worse

Symptoms: hypertension, edema, heart failure,

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8
Q

After volume overload, another concequence (second on the list) for CKD is hypocalcemia

Explain why hypocalcemia happens in CKD patients?

What other symptoms do you see in CKD patients due to hypocalcemia

A
  1. Volume Overload
  2. Hypocalcemia

The Proximal Convoluted Tubule is where vitamin D is activated to calcitriol via the enzyme 1-alpha hydroxylase. In CKD, that function is impaired.

So symptoms will be

  • low vitamin D/calcitriol levels
  • low calcium levels
  • high PTH levels
  • high serum phosphate
  • cramps, tingling
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9
Q

The third concequence of CKD is metabolic acidosis

Metabolic acidosis occurs later in the progression of the disease (after HTN and hypocalcemia)

Metabolic Acidosis generally doesn’t show up until the GFR is _____
Why does metabolic acidosis happen?

A

Metabolic acidosis usually progresses later in CKD

  1. Volume overload
  2. hypocalcemia
  3. metabolic acidosis

Metabolic acidosis doesn’t occur until GFR < 30

This happens because the kidney has a decreased ability to secrete protons by the distal tubule and collecting duct, and also decreased ability to generate bicarb.

NOTE: metabolic acidosis is made worse by western diet high in red meat (more acidic), if patient switches to vegetables and fruits (more alkali)

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10
Q

Hyperkelemia is another concenquence of CKD

Explain why hyperkelemia happens in CKD patients

What are symptoms associated with hyperkelemia?

A

CKD Concequence Progression

    1. volume overload
    1. hypocalcemia
    1. metabolic acidosis
    1. hyperkelemia

Hyperkelemia:

  • Aldosterone production is impaired in older patients and patients with diabetes.
  • Remember, aldosterone reabsorbs sodium but also excretes potassium.
  • Drugs that treat hypertension also inhibit aldoesterone production
  • symptoms: weakness, fatigue
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11
Q

Which cells secrete potassium in the distal tubule and collecting duct?

A

PRINCIPAL cells secrete K+

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12
Q

Type 4 Renal Tubular Acidosis:

____renin, ____aldosterone, ____kelemia, and metabolic acidosis

Resistance to aldosterone or not producing aldosterone at all

Seen in older patients with ____ and ___

A

Type 4 Renal Tubular Acidosis:
HYPOrenin, HYPOaldosterone, HYPERkelemia, and metabolic acidosis

Resistance to aldosterone or not producing aldosterone at all

Seen in older patients with diabetes and CKD

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13
Q

CKD patients also get anemia, when GFR < ___

Why do they get anemia?

How do you treat CKD induced anemia?

A

Anemia: when GFR < 45/40

CKD patients get anemia because the kidneys produce EPO (which you need to make new RBCs), and with ckd that function is impaired

Treat this with EPOGEN

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14
Q

Uremia:
CKD patients in later stages also get uremia

Uremia is due to accumulation of _____ and other molecules that are waste products in blood

What are early and late signs of uremia?

A

Uremia:

CKD patients in later stages also get uremia

Uremia is due to accumulation of P-cresol and other molecules that are waste products in blood

Early signs of uremia: fatigue and poor apetitide

Late signs of uremia: uremic frost, coma

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15
Q

The final stage of CKD progression is

ASTERIXIS

what does that mean?

A

Asterixis:

neurological condition due to build up of uremic toxins

Flapping hand tremors

Requires dialysis

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16
Q

Explain the progression of concequences of CKD

1.

2.

3.

4.

5.

6.

7

A

Concequences of CKD:

  1. FLuid and salt retention: hypertension
  2. Hypocalcemia

3, Acidosis

  1. Hyperkelemia
  2. Anemia
  3. Uremia
  4. Asterexis
17
Q

What is the most common type of kidney stone?

A

Most common types of stones are made of calcium

Calcium oxalate most common

calcium phosphate (less common)

This is due to hypercalcemia, BUT can be due to diet of high calcium OR high PTH levels

18
Q

Explain ESP/Equilibrium Solubility Product

If the solubility product is < ESP what happens?

If solubility product is > ESP what happen?

A

At the equlibirum point, stones neither grow nor shrink

Solubility product > ESP, stones will grow

Solubility product < ESP, stones will shrink

19
Q

_____ and ____ are both inhibitors of stone growth

How does both work?

A

Citrate and Magnesium are inhibitors of stone growth

Citrate

  • binds to calcium and prevents crystallization of calcium oxalate or calcium phosphate
  • increases urine pH which decreases precipitation of uric acid

Magnesium:

  • forms oxalate and phosphate salts which are more soluble than calcium salts
20
Q

Calcium Stones:
most common

due to hypercalciuria

increased intestinal _____ of calcium is a common find in patients with calcium stones

A

Calcium Stones:

most common

due to hypercalciuria

increased intenstinal absorption of calcium is a common find in these patients

21
Q

How does chronic diarrhea cause stones?

_____ volume urine

____ magnesium level

___ bicarb

____ pH

___citrate

A

Chronic Diarrhea causes stones due to volume depletion and low volume urine

LOW everything:
low volume urine

low magnesium (inhibitor)

low bicarb

low pH

low citrate

22
Q

Uric Acid Stones:

uric acid binds to two protons to form ____, which has low solubility in urine

What do they look like under a microscope?

These happen at ___ urine pH

How to treat them?

A

Uric Acid Stones:

uric acid binds to two protons to form ureate, LOW solubility

Radiotranslucent under microscope

happen at LOW urine pH
treat them with citrate to increase urine pH and dissolve the stones

23
Q

Staghorn Calculus:
These stones are caused by the compound _______

This is due to the presence of urease splitting organisms (______)

Which infection doesn’t cause staghorn calculus?

Staghorn calculus also happens with pH > 7

These HAVE to be surgically removed

A

Staghorn calculus:
stones are caused by struviate

Due to the presence of urease splitting organisms (infections)

E.Coli does not cause these stones

Staghorn calculus also happens with ph> 7

Have to be surgically removed

24
Q

Which stones are seen in high pH

In low pH

How to treat all stones?

A

Calcium phosphate stones: high pH

Uric acid stones: low pH

Treat all stones by increasing urine volume

Pathophysiology (17 decks)

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