Chronic Kidney Disease Overview G.32 - 4.2

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Questions and Answers

What is the primary effect of CKD on the kidneys?

  • Decrease in the volume of urine produced
  • Increase in the filtration rate of the glomeruli
  • Increase in the number of functional nephrons
  • Decrease in the number of functional nephrons (correct)

What is the primary mechanism by which CKD progresses to end-stage renal disease (ESRD)?

  • Increased blood flow to the kidneys
  • A vicious cycle of injury and adaptation (correct)
  • Overproduction of erythropoietin
  • Decreased levels of creatinine in the blood

Which of the following is NOT a factor that can contribute to the development of CKD?

  • Increased production of erythropoietin (correct)
  • Tubular disorders
  • Lower urinary tract disorders
  • Glomerular disorders

What is the primary mechanism by which increased pressure in the glomeruli contributes to CKD progression?

<p>Injury and sclerosis of the glomeruli (D)</p> Signup and view all the answers

How does the loss of functional nephrons in CKD impact the remaining nephrons?

<p>It increases the workload of the remaining nephrons (B)</p> Signup and view all the answers

What is the most effective method to slow down the progression of CKD to ESRD?

<p>Lowering arterial pressure and glomerular pressure (A)</p> Signup and view all the answers

CKD can be caused by disorders related to which of the following?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a common cause of end-stage renal disease (ESRD)?

<p>Excessive fluid intake (B)</p> Signup and view all the answers

What is the primary characteristic of nephrotic syndrome?

<p>Excessive protein loss in urine (B)</p> Signup and view all the answers

What is the primary cause of protein loss in the urine in nephrotic syndrome?

<p>Increased permeability of the glomerular membrane (D)</p> Signup and view all the answers

Which of the following is NOT a common cause of nephrotic syndrome?

<p>High blood pressure (C)</p> Signup and view all the answers

What is the primary difference between acute and chronic glomerulonephritis in terms of streptococcal infections?

<p>Streptococcal infections are a major cause of acute glomerulonephritis, but only a minor cause of chronic glomerulonephritis. (A)</p> Signup and view all the answers

What is the primary consequence of the progressive damage of renal tubules, glomeruli, and other structures in chronic glomerulonephritis?

<p>Development of chronic kidney disease (CKD). (D)</p> Signup and view all the answers

What happens to the glomerular capillary filtration coefficient in the later stages of chronic glomerulonephritis?

<p>It decreases due to the thickening of the glomerular membranes and the loss of capillaries. (D)</p> Signup and view all the answers

What is the main characteristic of interstitial nephritis?

<p>Inflammation of the renal interstitium. (C)</p> Signup and view all the answers

Why is the glomerular filtration coefficient reduced in the final stages of chronic glomerulonephritis?

<p>Replacement of glomeruli by fibrous tissue. (D)</p> Signup and view all the answers

What is the primary cause of damage to the kidneys in this specific type of AKI?

<p>The immune complex formed by antibodies and antigen obstructs the glomeruli. (A)</p> Signup and view all the answers

What happens to the glomerular cells once the immune complex is deposited?

<p>They begin to proliferate, particularly the mesangial cells. (D)</p> Signup and view all the answers

What is a likely consequence of the inflammatory reaction in the glomeruli?

<p>Increased permeability of the glomeruli, allowing protein and red blood cells to leak. (B)</p> Signup and view all the answers

Which of the following is NOT a cause of the specific type of AKI described in the text?

<p>Viral infection (D)</p> Signup and view all the answers

What is the primary cell type that proliferates in the glomeruli after immune complex deposition?

<p>Mesangial cells (C)</p> Signup and view all the answers

What effect does the blockage of glomeruli have on the filtration process?

<p>It decreases the overall filtration rate, potentially leading to waste accumulation. (B)</p> Signup and view all the answers

What is the timeframe for potential repair of the tubules, assuming the basement membrane remains intact?

<p>10 to 20 days (C)</p> Signup and view all the answers

What is the name of the category of AKI described in the text?

<p>Intrinsic AKI (C)</p> Signup and view all the answers

What happens to the sodium-potassium–adenosine triphosphatase pump (Na+-K+ ATPase pump) when sodium entry into the epithelial cells is decreased?

<p>Its activity decreases, resulting in decreased potassium secretion. (D)</p> Signup and view all the answers

What is the main reason for the high blood flow to the kidneys?

<p>To provide enough plasma for efficient glomerular filtration. (B)</p> Signup and view all the answers

What is the primary consequence of decreased renal blood flow?

<p>Reduced GFR (glomerular filtration rate) and urine output. (D)</p> Signup and view all the answers

Which of the following conditions can lead to prerenal acute kidney injury (AKI) by causing intravascular volume depletion?

<p>Hemorrhage after surgery. (B)</p> Signup and view all the answers

Why are sodium channel blockers considered potassium-sparing diuretics?

<p>They promote sodium loss while inhibiting potassium secretion, sparing potassium. (D)</p> Signup and view all the answers

What is the primary cause of postrenal AKI?

<p>Obstruction of the urinary collecting system. (B)</p> Signup and view all the answers

Which of the following conditions is NOT a direct cause of prerenal AKI?

<p>Kidney stones. (A)</p> Signup and view all the answers

Which of the following statements is TRUE about the relationship between sodium and potassium regulation in the kidney?

<p>Sodium reabsorption can indirectly influence potassium secretion, as decreased sodium reabsorption can lead to decreased potassium secretion. (B)</p> Signup and view all the answers

Which of these are metabolic disorders that can cause chronic kidney disease?

<p>Diabetes mellitus (A), Amyloidosis (B)</p> Signup and view all the answers

What are the primary causes of chronic kidney disease?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a renal vascular disorder that can cause chronic kidney disease?

<p>Glomerulonephritis (C)</p> Signup and view all the answers

What is the name of the primary kidney disease that can result in a vicious cycle of glomerular sclerosis, hypertrophy, and vasodilation of surviving nephrons?

<p>Glomerulonephritis (C)</p> Signup and view all the answers

What is the most likely outcome of untreated chronic kidney disease?

<p>Kidney failure (D)</p> Signup and view all the answers

Which of the following is NOT a primary tubular disorder?

<p>Diabetes mellitus (D)</p> Signup and view all the answers

Which of the following is a factor that can contribute to the vicious cycle of chronic kidney disease?

<p>Decreased glomerular filtration (B)</p> Signup and view all the answers

What is the primary difference between acute kidney injury (AKI) and chronic kidney disease (CKD)?

<p>AKI is a short-term condition, while CKD is a long-term condition. (C)</p> Signup and view all the answers

As the number of nephrons decreases below 5% to 10% of normal, what is the primary consequence for the patient?

<p>Increased electrolyte and fluid retention, leading to death (A)</p> Signup and view all the answers

Why do waste products like urea and creatinine accumulate in proportion to the number of nephrons lost?

<p>These waste products are not reabsorbed as efficiently by the remaining nephrons (C)</p> Signup and view all the answers

How does the body maintain relatively constant plasma concentrations of electrolytes like sodium and chloride despite a decrease in GFR?

<p>By significantly decreasing tubular reabsorption of these electrolytes (A)</p> Signup and view all the answers

Which of the following is TRUE regarding creatinine excretion?

<p>Creatinine excretion rate is directly proportional to GFR and plasma creatinine concentration (B)</p> Signup and view all the answers

When 75% of the nephrons are lost, how does the workload change for the remaining nephrons?

<p>The remaining nephrons must filter and excrete four times as much sodium and volume (B)</p> Signup and view all the answers

What is the relationship between the decline in GFR and the rise in plasma concentrations of electrolytes?

<p>Plasma concentrations rise, but not in proportion to the fall in GFR (C)</p> Signup and view all the answers

Which of the following best describes the mechanism by which the body maintains relatively constant plasma concentrations of urea and creatinine as GFR declines?

<p>Decreased tubular reabsorption of these substances (B)</p> Signup and view all the answers

What is the primary difference between the way the body manages the accumulation of electrolytes and waste products like urea and creatinine in the setting of declining GFR?

<p>Electrolytes are reabsorbed more readily than waste products in the tubules (D)</p> Signup and view all the answers

Flashcards

Postrenal Acute Kidney Injury

Kidney injury caused by obstruction of urinary flow.

Sodium-Potassium Pump

A pump that transports sodium out and potassium into cells.

Potassium-Sparing Diuretics

Diuretics that reduce potassium excretion.

Prerenal Acute Kidney Injury

AKI caused by reduced blood flow to the kidneys.

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Causes of Prerenal AKI

Includes intravascular volume depletion from hemorrhage, diarrhea, etc.

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Normal Renal Blood Flow

The kidneys receive about 1100 ml/min of blood.

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Glomerular Filtration Rate (GFR)

The rate at which blood is filtered in the kidneys.

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Urine Output

Volume of urine produced by the kidneys.

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AKI after infection

Acute Kidney Injury that occurs following a systemic infection, particularly from streptococcal bacteria.

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Immune complexes

Formed when antibodies react with streptococcal antigens, potentially damaging the kidneys.

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Glomeruli damage

Kidneys' filtering units become blocked or inflamed, leading to kidney dysfunction.

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Mesangial cell proliferation

Increase in mesangial cells in response to immune complex deposition, affecting kidney function.

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Tubular obstruction

Occurs when immune complexes and cells plug the renal tubules, impairing urine flow.

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Basement membrane integrity

Refers to the condition of the basement membrane that affects regeneration of renal tubules.

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Excessive permeability

Condition where glomeruli allow proteins and red blood cells to leak into urine.

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Postrenal AKI

Acute Kidney Injury caused by abnormalities in the lower urinary tract that obstruct urine flow.

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Acute Kidney Injury (AKI)

A sudden decline in kidney function leading to the buildup of waste in the blood.

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Chronic Kidney Disease (CKD)

A long-term condition where kidney function gradually declines over months or years.

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Renal Poisons

Substances that can damage kidney tissues and impair function.

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Diabetes Mellitus and CKD

Diabetes can lead to kidney damage and is a major cause of CKD.

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Hypertension in CKD

High blood pressure can damage blood vessels in the kidneys, leading to CKD.

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Nephrotoxins

Toxic substances like analgesics and heavy metals that can harm the kidneys.

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Glomerulonephritis

Inflammation of the kidney's filtering units, often leading to CKD.

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Urinary Tract Obstruction

Blockage in the urinary system that can cause kidney damage.

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Chronic Glomerulonephritis

A long-term kidney disease causing progressive damage to glomeruli.

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Nephrotic Syndrome

Condition characterized by excessive protein loss in urine due to increased glomerular permeability.

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Glomerular Capillary Filtration Coefficient

Measurement of the kidney's ability to filter blood at the glomeruli.

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Fibrous Tissue Invasion

Replacement of healthy glomeruli tissue with fibrous tissue leading to loss of function.

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Increased Permeability of Glomerular Membrane

Situation when the glomerular membrane allows too many substances to pass into urine.

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Interstitial Nephritis

Injury to the renal interstitium leading to chronic kidney disease.

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End-Stage Renal Disease (ESRD)

The final stage of chronic kidney disease, where kidney function is severely impaired.

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Vicious Cycle of CKD

A pattern where kidney damage leads to further damage and loss of nephrons.

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Increased Arterial Pressure

A condition where blood pressure in the kidneys rises, contributing to nephron injury.

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Glomerular Injury

Damage to the filtering units of the kidneys, impacting their ability to function.

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Nephron Sclerosis

The replacement of healthy nephron tissue with scar tissue, leading to loss of function.

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Functional Vasodilation

The widening of blood vessels that can lead to increased kidney pressure.

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Adaptive Changes in Nephrons

Responses of remaining nephrons to compensate for lost function, which can lead to further damage.

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Nephron Loss Effects

Electrolyte imbalance and fluid retention occur when nephron count drops below 5-10%.

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Waste Product Accumulation

Urea and creatinine levels rise according to nephron destruction.

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Creatinine Excretion Mechanics

Creatinine excretion rate equals GFR times plasma creatinine concentration.

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Sodium and Chloride Stability

Plasma concentrations of sodium and chloride remain stable despite decreased GFR.

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Increased Nephron Load

With 75% nephron loss, each surviving nephron must excrete more solutes.

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Tubular Reabsorption Role

Decreased tubular reabsorption maintains sodium and chloride levels during GFR decline.

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Creatinine Non-Reabsorption

Creatinine is not reabsorbed, and its excretion equals filtration rate.

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Glomerular Filtration Rate (GFR) Relation

GFR is crucial for the filtration of solutes like creatinine.

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Study Notes

Diuretics and Their Mechanisms of Action

  • Diuretics increase urine output and excretion of solutes, mainly sodium and chloride.
  • Most diuretics work by reducing renal tubular sodium reabsorption, leading to increased water and solute excretion.
  • Diuretics are clinically used to reduce extracellular fluid volume (edema) and in hypertension.
  • Some diuretics can increase urine output significantly (20-fold) after administration.

Osmotic Diuretics

  • Osmotic diuretics are substances filtered by the glomeruli but not readily reabsorbed in the renal tubules (e.g., urea, mannitol, sucrose).
  • They increase the concentration of osmotically active molecules in the tubules, reducing water reabsorption and increasing urine output.
  • Elevated blood glucose in diabetes mellitus can lead to osmotic diuresis, with excess glucose remaining in the tubules, increasing urine flow.

Loop Diuretics

  • Powerful diuretics like furosemide, ethacrynic acid, and bumetanide.
  • They block the sodium-chloride-potassium co-transporter in the thick ascending limb of the loop of Henle.
  • This reduces sodium, chloride, and potassium reabsorption, significantly increasing urine output.
  • Loop diuretics affect the countercurrent multiplier system, decreasing medullary interstitial fluid concentration, reducing the kidneys' ability to concentrate or dilute urine.

Thiazide Diuretics

  • Thiazide derivatives (e.g., chlorothiazide) mainly act on the early distal tubules.
  • They block the sodium-chloride co-transporter, decreasing sodium and chloride reabsorption and increasing urine output.
  • The maximum effect of these diuretics is typically 5-10% of the glomerular filtrate.

Carbonic Anhydrase Inhibitors

  • Acetazolamide inhibits the carbonic anhydrase enzyme essential for bicarbonate reabsorption in the proximal tubules.
  • This decreases sodium reabsorption leading to increased urine output.
  • Side effect: causes acidosis due to excessive bicarbonate loss in urine.

Mineralocorticoid Receptor Antagonists

  • Spironolactone and eplerenone compete with aldosterone for receptor sites in the collecting tubules.
  • Decreasing sodium reabsorption and increasing potassium secretion.
  • Referred to as potassium-sparing diuretics.

Sodium Channel Blockers

  • Amiloride and triamterene block sodium entry into the sodium channels of collecting tubule cells.
  • Decreasing sodium reabsorption and potassium secretion.
  • Potassium-sparing diuretics.

Kidney Diseases

  • Kidney diseases are significant causes of mortality and morbidity worldwide.
  • Acute kidney injury (AKI) is an abrupt loss of kidney function.
  • Chronic kidney disease (CKD) involves progressive loss of nephron function and function. -Prerenal, Intrarenal, Postrenal
  • Causes of AKI include decreased blood supply, intrarenal abnormalities, and postrenal obstructions.
  • CKD's causes include factors like diabetes, hypertension, glomerulonephritis, and other conditions.

Acute Kidney Injury (AKI)

  • AKI results from decreased blood supply, intrarenal or postrenal conditions.
  • Pre-renal AKI: reduced kidney supply, e.g., heart failure, or reduced blood volume.
  • Intrarenal AKI: conditions within the kidney itself, e.g., tubular necrosis, vasculitis.
  • Postrenal AKI: obstruction to urine flow, e.g., kidney stones.

Chronic Kidney Disease (CKD)

  • CKD results in progressive loss of nephron function, often leading to end-stage renal disease (ESRD).

Other Kidney Disorders

  • Tubular Necrosis, Nephrotic Syndrome

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Guyton Ch 32 PDF - Diuretics and Kidney Diseases

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