Medicine Marrow Pg No 805-814 (Nephrology)
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Questions and Answers

What is osteitis fibrosa cystica primarily associated with?

  • Increased phosphate levels (correct)
  • High calcium levels
  • Adynamic bone disease
  • Decreased GFR

    • Secondary hyperparathyroidism is characterized by hypocalcemia and hypophosphatemia.

    False

    What enzyme's inhibition leads to calcitriol deficiency in patients with CKD?

    1,25-dihydroxyvitamin D 1-alpha-hydroxylase (1,2 hydroxylase)

    In chronic kidney disease, the glomerular filtration rate (GFR) tends to _____ significantly.

    <p>decrease</p> Signup and view all the answers

    Match the following conditions with their definitions:

    <p>Osteitis fibrosa cystica = Condition caused by increased phosphate levels Adynamic bone disease = Lower bone turnover often in elderly women with diabetes Left ventricular hypertrophy = Heart condition related to CKD Secondary Hyperparathyroidism = Increased parathyroid activity in response to hypocalcemia</p> Signup and view all the answers

    What is the most common cause of anemia in chronic kidney disease?

    <p>Decreased RBC production</p> Signup and view all the answers

    In chronic kidney disease, elevated levels of erythropoietin (EPO) contribute to anemia.

    <p>False</p> Signup and view all the answers

    What effect does hypoxia have on erythropoietin production?

    <p>It triggers the activation of Hypoxia-Inducible Factor-alpha (HIF-α), leading to reduced EPO production.</p> Signup and view all the answers

    Chronic inflammation stimulates the production of __________, which contributes to anemia.

    <p>hepcidin</p> Signup and view all the answers

    Match the following complications of anemia in chronic kidney disease with their consequences:

    <p>Left Ventricular Hypertrophy (LVH) = Increased cardiovascular mortality Calcification = Impaired blood vessel function Endothelial Dysfunction = Increased risk of cardiovascular events Uremic Toxins = Inhibition of erythropoiesis</p> Signup and view all the answers

    What is the primary consequence of a decrease in the number of viable nephrons in chronic kidney disease?

    <p>Intraglomerular hypertension and proteinuria</p> Signup and view all the answers

    Viable nephrons can be regenerated or replaced after birth.

    <p>False</p> Signup and view all the answers

    What is the most common cause of chronic kidney disease?

    <p>Diabetic Kidney Disease (DKD)</p> Signup and view all the answers

    The primary determinant of renal function decline in chronic kidney disease is the __________.

    <p>tubulointerstitium</p> Signup and view all the answers

    Match the following conditions with their descriptions:

    <p>Diabetic Kidney Disease = Most common cause of chronic kidney disease Chronic Glomerulonephritis = Damage to the glomeruli Ischemic nephropathy = Reduced blood flow to the kidneys Adult polycystic kidney disease = Genetic condition causing cysts in kidneys</p> Signup and view all the answers

    Which of the following iron therapies is administered intravenously?

    <p>Both B and C</p> Signup and view all the answers

    EPO-α has a half-life of 8.5 hours.

    <p>True</p> Signup and view all the answers

    What is the prerequisite to start EPO therapy in terms of TSAT?

    <p>TSAT ≥30%</p> Signup and view all the answers

    Daprodustat is classified as a _______ hydroxylase inhibitor.

    <p>prolyl</p> Signup and view all the answers

    Match the drugs with their characteristics:

    <p>EPO-β (CERA) = 0.6 µg/kg weekly Darbepoetin = 60-200 µg/2 weekly Daprodustat = Prolyl hydroxylase inhibitor EPO-α = T1/2: 8.5 hrs</p> Signup and view all the answers

    What can cause anemia in patients with chronic kidney disease?

    <p>Decreased Glomerular Filtration Rate (GFR)</p> Signup and view all the answers

    Anemia can develop independently of changes in the Glomerular Filtration Rate (GFR) in chronic kidney disease.

    <p>False</p> Signup and view all the answers

    What is the primary condition that leads to anemia in chronic kidney disease?

    <p>Decreased Glomerular Filtration Rate (GFR)</p> Signup and view all the answers

    Anemia appears in chronic kidney disease when the Glomerular Filtration Rate (GFR) __________.

    <p>decreases</p> Signup and view all the answers

    Match the following terms related to chronic kidney disease with their correct descriptions:

    <p>Anemia = A condition often resulting from decreased GFR Glomerular Filtration Rate (GFR) = A measure of kidney function Chronic Kidney Disease = Long-term impairment of kidney function Erythropoietin = Hormone that stimulates red blood cell production</p> Signup and view all the answers

    What is the leading cause of mortality in ESRD patients?

    <p>Cardiac causes</p> Signup and view all the answers

    Younger patients with CKD have a significantly lower risk of cardiac disease compared to the control population.

    <p>False</p> Signup and view all the answers

    What is the best marker for myocardial infarction in CKD patients?

    <p>Trop-1</p> Signup and view all the answers

    In CKD, preserved ejection fraction (EF) is often associated with _________.

    <p>heart failure</p> Signup and view all the answers

    Match the conditions with their corresponding features in CKD:

    <p>Uremic Cardiomyopathy = Causes pericarditis and arrhythmias Left Ventricular Hypertrophy (LVH) = Enlargement of the heart's left ventricle Medial Calcification = Calcium deposits in arteries Dysbiosis = Disruption of gut microbiota</p> Signup and view all the answers

    Which of the following is a clinical feature of Calciphylaxis?

    <p>Violaceous painful plaque</p> Signup and view all the answers

    Patients with CKD should strictly avoid calcium and Vitamin D supplements.

    <p>False</p> Signup and view all the answers

    What is the primary cause of Nephrogenic Systemic Fibrosis?

    <p>Gadolinium-based contrast</p> Signup and view all the answers

    In the case of Calciphylaxis, the arterioles undergo medial __________ due to vasculopathy.

    <p>calcification</p> Signup and view all the answers

    Match the body part with its corresponding image description related to Calciphylaxis:

    <p>Leg = Image A Buttocks = Image B Abdomen = Image C Thigh = Image D</p> Signup and view all the answers

    Which of the following is NOT an indication for dialysis?

    <p>Severe headache</p> Signup and view all the answers

    A holistic approach to CKD treatment should include the use of tobacco products.

    <p>False</p> Signup and view all the answers

    What is the target LDL level for patients with diabetic CKD?

    <p>70 mg/dL</p> Signup and view all the answers

    The first-line drug therapy for managing proteinuria includes ACE(-) or ARBS and _____ for most patients.

    <p>SGLT2</p> Signup and view all the answers

    Match the following components with their respective descriptions:

    <p>AV fistula = Access creation for dialysis Finerenone = 2nd line drug therapy for proteinuria Uremia symptoms = Definitive indication for dialysis Salt restriction = Lifestyle modification for CKD</p> Signup and view all the answers

    What could be a hurdle for a patient fit for transplantation?

    <p>Medial calcifications</p> Signup and view all the answers

    The mortality rates after the initiation of dialysis decrease over time.

    <p>False</p> Signup and view all the answers

    What is the main reason for creating an AV fistula before dialysis treatment?

    <p>To allow for adequate access for dialysis</p> Signup and view all the answers

    What is the GFR range for Stage G3a in kidney classification?

    <p>45 - 59 ml/min</p> Signup and view all the answers

    Cardiac complications are the most common cause of death in kidney disease.

    <p>True</p> Signup and view all the answers

    List two reversible causes of kidney dysfunction.

    <p>Obstruction, Uncontrolled hypertension</p> Signup and view all the answers

    Stage G4 of kidney classification corresponds to a GFR of _____ ml/min.

    <p>15 - 29</p> Signup and view all the answers

    Match the following complications with their characteristics:

    <p>Anemia = Low red blood cell count Acidosis = Excess acid in the body Bone Mineral Disease = Renal osteodystrophy Electrolyte imbalance = Disruption of essential minerals</p> Signup and view all the answers

    Which of the following is a first-line treatment for high bone turnover in CKD?

    <p>Sevelamer Carbonate</p> Signup and view all the answers

    Pure phosphate binders can lead to decreased LDL levels.

    <p>True</p> Signup and view all the answers

    What is the target calcium level in CKD management?

    <p>&lt; 9.5</p> Signup and view all the answers

    In chronic kidney disease, the normal range for PTH is __________ pg/ml.

    <p>50-100</p> Signup and view all the answers

    Match the following treatments with their related features:

    <p>Sevelamer Carbonate = Lowers LDL levels Ferric citrate = Phosphate binder Calcitriol = Vitamin D treatment Calcium phosphate binders = Used in significant hypocalcemia</p> Signup and view all the answers

    Study Notes

    Anemia in Chronic Kidney Disease

    • Anemia is a common complication of chronic kidney disease (CKD) and can be caused by decreased red blood cell (RBC) production or decreased RBC survival.
    • Decreased RBC production is more common and is due to low iron levels, poor iron absorption, and blood loss.
    • Decreased RBC survival is less common and is due to increased RBC destruction or reduced red blood cell lifespan.

    Hypoxia-Inducible Factor (HIF)-alpha

    • Hypoxia (low oxygen) triggers the activation of HIF-alpha.
    • HIF-alpha stimulates erythropoietin (EPO) production in the kidneys, leading to increased RBC production.
    • In CKD, the kidneys are damaged and lose their ability to produce EPO, leading to anemia.
    • Inflammation and other factors contribute to anemia in CKD.

    Iron Therapy

    • Iron therapy is the first step in managing anemia in CKD.
    • Iron deficiency is the most common cause of ESA hyporesponsiveness.
    • Formulas are available to determine iron requirements.
    • Oral iron supplements are less effective than intravenous iron therapy.
    • Intravenous iron therapy is preferred for patients with significant iron deficiency.

    EPO Stimulating Agents (ESA)

    • ESA are used to stimulate red blood cell production.
    • ESA are only given to patients with adequate iron stores.
    • EPO-alpha and EPO-beta are commonly used ESA.
    • Darbepoetin is a long-acting EPO-beta that may increase the hematocrit more effectively than EPO-alpha.
    • Daprodustat is prolyl hydroxylase inhibitor which may be a future alternative to ESA.

    Chronic Kidney Disease (CKD)

    • CKD is a progressive disease that leads to a decline in glomerular filtration rate (GFR).
    • The number of viable nephrons declines in CKD, which causes intraglomerular hypertension and proteinuria.
    • GFR can be calculated using different methods:
      • Cockcroft-Gault formula
      • MDRD equation
      • CKD-EPI equation

    Management of CKD

    • Lifestyle modifications are essential for managing CKD.
    • Medications can be used to manage proteinuria, hypertension, and other complications.
    • Dialysis may be needed for patients with advanced CKD.
    • Kidney transplantation may be an option for some patients.

    CKD - Mineral Bone Disease

    • CKD-MBD is a complex disorder that affects bone metabolism.
    • High bone turnover is characterized by osteitis fibrosa cystica.
    • Low bone turnover is characterized by adynamic bone disease.
    • Calcification is a common complication of CKD-MBD.
    • Treatment of CKD-MBD involves managing phosphate levels, calcium levels, and vitamin D levels.
    • Phosphate binders are the first-line treatment for hyperphosphatemia.
    • Calcitriol is a vitamin D analogue that can be used to treat hypocalcemia and hyperparathyroidism.
    • Bisphosphonates can be used to treat low bone mass.
    • Calcium and vitamin D supplements should be used with caution in CKD patients.

    CKD - Cardiovascular System

    • Cardiovascular disease is a major cause of death in CKD patients.
    • CKD patients have an increased risk of heart disease and hypertension.
    • Uremic toxins contribute to cardiovascular disease in CKD.
    • Early diagnosis and treatment of cardiovascular disease are essential in CKD patients.
    • Pre-transplant evaluation for vascular calcification is mandatory.

    Telegram channel - @back_ed8

    • The Telegram channel @back_ed8 contains more information on nephrology.

    Nephrology

    • This appears to be the label or a reference to a specific section within the document.

    Rate of Fall of GFR (ml/min/year)

    • The rate of decline in GFR varies depending on the underlying cause of CKD.
    • DKD (Diabetic Kidney Disease) is the most common cause with a rapid rate of decline in GFR.
    • CGN (Chronic Glomerulonephritis) has a moderate rate of decline in GFR.
    • IN (Ischemic Nephropathy) has a slower rate of decline in GFR.
    • CTID (Chronic Tubulointerstitial Disease) has the slowest rate of decline in GFR.

    Classification (GFR)

    • The stages of CKD are classified based on GFR.
    • Stage 1 is characterized by GFR > 90 ml/min.
    • Stage 5 is characterized by GFR <15 ml/min or end-stage renal disease (ESRD).

    Complications (Mnemonic: ABCDE)

    • Common complications of CKD:
      • Anemia
      • Acidosis
      • Access for dialysis
      • Bone mineral disease
      • Cardiac complications
      • Dry weight
      • Electrolyte imbalances
      • Uremia

    Management

    • Diagnosis of CKD is based on:
      • Presence of kidney damage
      • Decreased GFR
      • History of CKD
    • Treatment:
      • Address reversible causes.
      • Manage complications.
      • Monitor GFR.

    CKD - Calciphylaxis & Cardiovascular Changes

    • Calciphylaxis is a rare but serious complication of CKD.

    • It is characterized by painful, ischemic necrosis of the skin and subcutaneous fat.

    • The pathogenesis of calciphylaxis is complex and involves hyperphosphatemia, vitamin K deficiency, and vascular calcification.

    • It is associated with a high mortality rate.

    • Treatment usually involves supportive care, wound care, and treatment of hyperphosphatemia.

    • The document lists specific figures and tables.

    • The document is a protocol or treatment guide for chronic kidney disease (CKD).

    • Some of the tables and graphs are related to dialysis, particularly the "Total Glomerular Filtration Rate (GFR)" and "Plasma Concentration" graphs.

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    Description

    This quiz explores the relationship between anemia and chronic kidney disease (CKD), including causes, mechanisms, and management strategies. It highlights the role of iron therapy and hypoxia-inducible factors in erythropoiesis. Test your knowledge on how to address anemia in CKD patients effectively.

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