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

    What stimulates PTH production in CKD patients?

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

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

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

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

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

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

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

    What is a potent mediator of vascular calcification?

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

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

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

    What is the target hemoglobin level according to KDOQI guidelines?

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

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

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

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

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

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

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

    What is the target serum ferritin level in CKD patients?

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

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

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

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

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

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

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

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

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

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

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

    What is a possible cause of glomerular scarring and proteinuria?

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

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

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

    What is the effect of Angiotensin II on postglomerular arterioles?

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

    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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    Description

    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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