38 Questions
What is the outcome of the involvement of all the growth factors mentioned in CKD?
Interstitial fibrosis
Which of the following is NOT a characteristic of Stage 1 CKD?
Severe decrease in GFR
What is the GFR range for Stage 3 CKD?
30 - 59 ml/min/1.73m2
What is the primary cause of hypocalcaemia in CKD patients?
All of the above
What is the increased risk of fractures in CKD Stage 5 patients compared to the general population?
4 times
What is the outcome of raised levels of serum phosphate in CKD patients?
Decreased intestinal absorption of calcium
What stimulates PTH production in CKD patients?
Hypocalcaemia
What is the primary factor leading to osteodystrophy in CKD patients?
All of the above
What is the most common cause of death in those on dialysis?
Accelerated atherosclerosis
What is the result of an intercurrent illness or surgery in a patient receiving adequate dialysis?
Dialysis pericarditis
What is now thought to be an active process in uraemia?
Vascular calcification
What is a potent mediator of vascular calcification?
Inflammation
What is elevated in CKD patients, contributing to cardiovascular risk?
All of the above
What is the role of the immune system in a normal environment?
It helps to keep arteries clear of lipid
What is the target hemoglobin level according to KDOQI guidelines?
Hb 10-12 g/dL
At what level of serum creatinine and GFR decline does anemia typically develop in patients with chronic kidney disease?
Serum creatinine > 180 mcg/L and GFR < 30 ml/minute
What is the consequence of high hemoglobin levels in patients on hemodialysis?
Increased risk of coronary events
What is the main cause of anemia in patients with chronic kidney disease?
Decrease production of erythropoietin (EPO)
What is the first line of management for anemia in CKD patients?
Iron supplementation
How often should screening for anemia be done in patients with CKD stage 3?
Annually
What is the target percent transferrin saturation (T-SAT) in CKD patients?
> 0.3
What is the target serum ferritin level in CKD patients?
> 500 ng/ml
What is the typical characteristic of anemia in patients with chronic kidney disease?
Normocytic, normochrome anemia
What is the primary mechanism of platelet dysfunction in patients with chronic kidney disease?
Impaired platelet-endothelium interaction
When should iron supplementation be withheld in CKD patients?
T-SAT > 50, S.ferritin > 800 ng/ml
What is the recommended daily dose of elemental iron for non-dialysis patients with CKD?
100-200 mg
What is a characteristic symptom of neuropathic pain in patients with chronic kidney disease?
Pain relief with movement
What is a sign of encephalopathy in patients with chronic kidney disease?
Flapping tremor and hiccups
What is the route of administration for iron supplementation in CKD patients?
Oral
What is the definitive treatment for anemia in patients with chronic kidney disease?
Renal transplantation
What is a common indicator of bad prognosis in patients with CKD?
Hypertension
What is a possible cause of glomerular scarring and proteinuria?
A rise in intraglomerular capillary pressure
What is the effect of Angiotensin II on mesangial cells and podocytes?
Increases pore sizes and impairs size-selective function of basement membrane
What happens to afferent arteriolar tone compared to efferent arteriolar tone in CKD?
Afferent arteriolar tone decreases more than efferent arteriolar tone
What is the primary effect of Angiotensin II on glomerular hydraulic pressure?
Increases glomerular hydraulic pressure
What is a characteristic of patients with chronic glomerular diseases?
They tend to deteriorate more quickly than those with chronic tubulointerstitial nephropathies
What is the effect of reduced nephron mass on glomerular blood flow and filtration fraction?
Increases glomerular blood flow and filtration fraction
What is the effect of Angiotensin II on postglomerular arterioles?
Causes vasoconstriction of postglomerular arterioles
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
This quiz covers the stages of Chronic Kidney Disease (CKD) and the growth factors involved in CKD, including their role in interstitial fibrosis.
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