CKD Stages and Growth Factors

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Questions and Answers

What is the outcome of the involvement of all the growth factors mentioned in CKD?

  • Nephrosclerosis
  • Interstitial fibrosis (correct)
  • Tubular atrophy
  • Glomerulosclerosis

Which of the following is NOT a characteristic of Stage 1 CKD?

  • Kidney damage
  • Normal or increased GFR
  • Mild symptoms
  • Severe decrease in GFR (correct)

What is the GFR range for Stage 3 CKD?

  • 90 - 100 ml/min/1.73m2
  • 15 - 29 ml/min/1.73m2
  • 60 - 89 ml/min/1.73m2
  • 30 - 59 ml/min/1.73m2 (correct)

What is the primary cause of hypocalcaemia in CKD patients?

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

What is the increased risk of fractures in CKD Stage 5 patients compared to the general population?

<p>4 times (C)</p> Signup and view all the answers

What is the outcome of raised levels of serum phosphate in CKD patients?

<p>Decreased intestinal absorption of calcium (B)</p> Signup and view all the answers

What stimulates PTH production in CKD patients?

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

What is the primary factor leading to osteodystrophy in CKD patients?

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

What is the most common cause of death in those on dialysis?

<p>Accelerated atherosclerosis (A)</p> Signup and view all the answers

What is the result of an intercurrent illness or surgery in a patient receiving adequate dialysis?

<p>Dialysis pericarditis (A)</p> Signup and view all the answers

What is now thought to be an active process in uraemia?

<p>Vascular calcification (A)</p> Signup and view all the answers

What is a potent mediator of vascular calcification?

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

What is elevated in CKD patients, contributing to cardiovascular risk?

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

What is the role of the immune system in a normal environment?

<p>It helps to keep arteries clear of lipid (C)</p> Signup and view all the answers

What is the target hemoglobin level according to KDOQI guidelines?

<p>Hb 10-12 g/dL (C)</p> Signup and view all the answers

At what level of serum creatinine and GFR decline does anemia typically develop in patients with chronic kidney disease?

<p>Serum creatinine &gt; 180 mcg/L and GFR &lt; 30 ml/minute (A)</p> Signup and view all the answers

What is the consequence of high hemoglobin levels in patients on hemodialysis?

<p>Increased risk of coronary events (C)</p> Signup and view all the answers

What is the main cause of anemia in patients with chronic kidney disease?

<p>Decrease production of erythropoietin (EPO) (C)</p> Signup and view all the answers

What is the first line of management for anemia in CKD patients?

<p>Iron supplementation (D)</p> Signup and view all the answers

How often should screening for anemia be done in patients with CKD stage 3?

<p>Annually (B)</p> Signup and view all the answers

What is the target percent transferrin saturation (T-SAT) in CKD patients?

<p>&gt; 0.3 (C)</p> Signup and view all the answers

What is the target serum ferritin level in CKD patients?

<p>&gt; 500 ng/ml (C)</p> Signup and view all the answers

What is the typical characteristic of anemia in patients with chronic kidney disease?

<p>Normocytic, normochrome anemia (C)</p> Signup and view all the answers

What is the primary mechanism of platelet dysfunction in patients with chronic kidney disease?

<p>Impaired platelet-endothelium interaction (A)</p> Signup and view all the answers

When should iron supplementation be withheld in CKD patients?

<p>T-SAT &gt; 50, S.ferritin &gt; 800 ng/ml (D)</p> Signup and view all the answers

What is the recommended daily dose of elemental iron for non-dialysis patients with CKD?

<p>100-200 mg (B)</p> Signup and view all the answers

What is a characteristic symptom of neuropathic pain in patients with chronic kidney disease?

<p>Pain relief with movement (D)</p> Signup and view all the answers

What is a sign of encephalopathy in patients with chronic kidney disease?

<p>Flapping tremor and hiccups (C)</p> Signup and view all the answers

What is the route of administration for iron supplementation in CKD patients?

<p>Oral (B)</p> Signup and view all the answers

What is the definitive treatment for anemia in patients with chronic kidney disease?

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

What is a common indicator of bad prognosis in patients with CKD?

<p>Hypertension (B)</p> Signup and view all the answers

What is a possible cause of glomerular scarring and proteinuria?

<p>A rise in intraglomerular capillary pressure (D)</p> Signup and view all the answers

What is the effect of Angiotensin II on mesangial cells and podocytes?

<p>Increases pore sizes and impairs size-selective function of basement membrane (C)</p> Signup and view all the answers

What happens to afferent arteriolar tone compared to efferent arteriolar tone in CKD?

<p>Afferent arteriolar tone decreases more than efferent arteriolar tone (B)</p> Signup and view all the answers

What is the primary effect of Angiotensin II on glomerular hydraulic pressure?

<p>Increases glomerular hydraulic pressure (C)</p> Signup and view all the answers

What is a characteristic of patients with chronic glomerular diseases?

<p>They tend to deteriorate more quickly than those with chronic tubulointerstitial nephropathies (D)</p> Signup and view all the answers

What is the effect of reduced nephron mass on glomerular blood flow and filtration fraction?

<p>Increases glomerular blood flow and filtration fraction (C)</p> Signup and view all the answers

What is the effect of Angiotensin II on postglomerular arterioles?

<p>Causes vasoconstriction of postglomerular arterioles (B)</p> Signup and view all the answers

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Study Notes

Growth Factors Involved in CKD

  • Platelet-derived growth factor, transforming growth factor-B, osteopontin, and endothelin are all growth factors that contribute to interstitial fibrosis.

CKD Stages

  • Stage 1: Kidney damage with normal or increased GFR (>90 ml/min/1.73m²)
  • Stage 2: Mild decrease in GFR (60-89 ml/min/1.73m²)
  • Stage 3: Moderate decrease in GFR (30-59 ml/min/1.73m²)
  • Stage 4: Severe decrease in GFR (15-29 ml/min/1.73m²)
  • Stage 5: Kidney failure, ESRD (<15 ml/min/1.73m²)

Cardiovascular Risk Factors in CKD Patients

  • Classical risk factors for atherosclerosis:
    • Raised (calcium × phosphate) product
    • Hyperparathyroidism
    • Vascular calcification
    • Inflammation
  • Other cardiovascular risk factors:
    • Homocysteinaemia
    • Chlamydia pneumoniae infection
    • Oxidative stress
    • Elevated endogenous inhibitor of nitric oxide synthase and asymmetric dimethyl arginine (ADMA) levels

Anemia in CKD Patients

  • Main cause: Decreased production of EPO
  • Other causes: +Retention of bone marrow toxins
    • Bone marrow fibrosis secondary to hyperparathyroidism
    • Deficiency of iron, vitamin B12, or folate
    • Increased RBC destruction
    • Abnormal RBC membrane
    • Use of ACE inhibitors

Platelet Dysfunction

  • Platelet count is normal, but platelet function is abnormal
  • Low VWF (von Willebrand factor) levels
  • Impaired platelet-endothelium interaction
  • Bleeding time is investigated to assess platelet function

Management of Anemia in CKD Patients

  • Target Hb/Hct levels: 10-12 g/dL and 33-36%, respectively
  • Iron supplementation is the first-line treatment for anemia
  • Target iron levels: T-SAT > 0.3 and S. ferritin > 500 ng/ml
  • Iron supplementation should be withheld if T-SAT > 50 and S. ferritin > 800 ng/ml

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