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Questions and Answers

Which of the following is NOT typically a secondary condition associated with end-stage chronic kidney disease?

  • Metabolic acidosis
  • Anemia
  • Hypertension
  • Hypokalemia (correct)

Electrolyte imbalance is a common secondary condition in end-stage chronic kidney disease.

True (A)

Define renal osteodystrophy and explain its relevance to chronic kidney disease.

Renal osteodystrophy is a bone disease that occurs when the kidneys fail to maintain proper levels of calcium and phosphorus in the blood. It is relevant to chronic kidney disease because the failing kidneys are unable to activate vitamin D, which is needed for calcium absoprtion.

______ is a life-threatening condition related to potassium levels that can cause cardiac arrest/death.

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

Match the secondary conditions with their related physiological imbalances in end-stage chronic kidney disease:

<p>Anemia = Deficiency in red blood cells Metabolic acidosis = Excessive accumulation of acids in the body Electrolyte imbalance = Disruption in the balance of minerals in the body Azotemia/uremic syndrome = Build-up of nitrogenous waste products in the blood</p> Signup and view all the answers

Azotemia, a condition associated with end-stage chronic kidney disease, is characterized by:

<p>High levels of nitrogenous waste products in the blood (B)</p> Signup and view all the answers

Depression is not typically observed as a secondary condition in patients with end-stage chronic kidney disease.

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

How does end-stage chronic kidney disease contribute to the development of hypertension?

<p>End-stage chronic kidney disease contributes to hypertension due to impaired sodium and water excretion, increased production of hormones that raise BP, and increased activity of the sympathetic nervous system.</p> Signup and view all the answers

Which secondary condition of end-stage chronic kidney disease directly poses an immediate, life-threatening risk related to cardiac function?

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

In renal osteodystrophy, the failing kidneys are unable to activate vitamin ______, needed for calcium absorption.

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

What is the primary reason for anemia in end-stage renal disease (ESRD)?

<p>Low erythropoietin production by the kidneys (D)</p> Signup and view all the answers

Uremia in ESRD can extend the lifespan of red blood cells.

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

List three common symptoms associated with anemia in ESRD.

<p>Fatigue, pallor, shortness of breath</p> Signup and view all the answers

Renal osteodystrophy occurs because the kidneys fail to regulate __________ and __________, leading to weak bones.

<p>calcium, phosphorus</p> Signup and view all the answers

In renal osteodystrophy, what hormonal change leads to bone breakdown?

<p>Increased parathyroid hormone (CPTHO) (B)</p> Signup and view all the answers

Match each condition with its primary cause in ESRD:

<p>Anemia = Low erythropoietin production Uremia = Shortened RBC lifespan Renal Osteodystrophy = Failure to regulate calcium and phosphorus Bone Breakdown = Increased parathyroid hormone</p> Signup and view all the answers

High phosphorus and high calcium levels lead to increased parathyroid hormone in ESRD

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

Which electrolyte imbalance contributes to increased parathyroid hormone release in renal osteodystrophy?

<p>High phosphorus, low calcium (B)</p> Signup and view all the answers

If a patient with ESRD experiences both anemia and renal osteodystrophy, what are the two main underlying issues related to kidney function?

<p>Low erythropoietin production, inability to regulate calcium and phosphorus</p> Signup and view all the answers

The increased levels of parathyroid hormone in renal osteodystrophy directly contribute to __________ __________ .

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

What is the nature of nephron loss in chronic kidney disease?

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

Hypertension is not considered a common cause of chronic kidney disease.

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

What is the most common cause of chronic kidney disease?

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

__________is the most common cause of chronic kidney disease.

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

Which of the following conditions or factors is NOT listed as a common cause of chronic kidney disease?

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

Chronic kidney disease always leads to complete kidney failure within a year of diagnosis.

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

Which of the following conditions is an inflammatory condition of the kidney and may lead to chronic kidney disease?

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

Which age group is at higher risk for chronic kidney disease?

<p>Adults &gt; 65 (B)</p> Signup and view all the answers

Besides diabetes and hypertension, name one other common cause of chronic kidney disease.

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

Damage from chronic kidney disease is partially reversible with proper treatment and care.

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

In the prodromal phase of acute tubular necrosis, what changes are typically observed in serum BUN and creatinine levels?

<p>Rising BUN and creatinine (D)</p> Signup and view all the answers

During the oliguric phase of acute tubular necrosis, urine output typically increases significantly.

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

What is the primary characteristic of the postoliguric phase of acute tubular necrosis regarding kidney function and urine output?

<p>Kidneys start recovering and urine output increases (diuresis phase).</p> Signup and view all the answers

In the oliguric phase of acute tubular necrosis, fluid retention, hyperkalemia, and __________ occur due to toxic waste buildup.

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

Which phase of acute tubular necrosis is characterized by kidneys starting to recover, leading to increased urine output?

<p>Postoliguric phase (A)</p> Signup and view all the answers

The duration of the prodromal phase of acute tubular necrosis is independent of the severity of the initial kidney injury.

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

What is a common clinical intervention that might be required during the oliguric phase of acute tubular necrosis?

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

During which phase of acute tubular necrosis does urine output typically drop to between 50-400 mL/day?

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

In acute tabular necrosis, the increase in urine output during the kidneys recovery is also refered as __________ phase.

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

Match each phase of acute tubular necrosis (ATN) with its corresponding characteristic:

<p>Prodromal Phase = Rising Serum BUN and Creatinine Oliguric Phase = Urine Output Drops to 50-400 mL/day Postoliguric Phase = Kidneys Start Recovering</p> Signup and view all the answers

Ischemia directly leads to acute tubular necrosis.

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

A lack of blood supply, known as __________, can result in acute damage to kidney tubules.

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

What is the primary consequence of ischemia in the context of kidney tubules?

<p>Acute tubular necrosis (D)</p> Signup and view all the answers

Briefly explain how ischemia results in acute tubular necrosis.

<p>Ischemia reduces blood flow, depriving kidney tubules of oxygen and nutrients, which leads to cell death and acute tubular necrosis.</p> Signup and view all the answers

Match the term with its description:

<p>Ischemia = Insufficient blood supply to an organ. Acute Tubular Necrosis = Damage and death of kidney tubule cells.</p> Signup and view all the answers

Which condition is characterized by damage and death of tubular cells in the kidneys due to insufficient blood supply?

<p>Acute Tubular Necrosis (B)</p> Signup and view all the answers

Acute tubular necrosis can occur independently of ischemia.

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

If a patient's kidney tubules are found to be damaged due to a lack of oxygen, which condition likely occurred?

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

The process of cell death from ischemia leading to acute tubular necrosis, highlights the kidney's vulnerability to _______ deprivation.

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

Differentiate between ischemia and acute tubular necrosis.

<p>Ischemia refers to reduced blood flow to the kidneys, which can lead to acute tubular necrosis, the death of tubular cells.</p> Signup and view all the answers

Which of the following conditions is NOT typically associated with prerenal AKI?

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

Prolonged postrenal AKI can lead to acute tubular necrosis (ATN) and irreversible kidney damage.

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

__________ AKI is often caused by direct kidney damage from infections, toxins, or ischemia.

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

What is the primary mechanism by which vascular injury leads to kidney damage in intrinsic/intrarenal AKI?

<p>Decreased blood flow, hypoxia, and vasoconstriction (B)</p> Signup and view all the answers

Match the type of AKI with its primary cause:

<p>Prerenal AKI = Reduced kidney perfusion Postrenal AKI = Obstruction of urine flow Intrinsic/Intrarenal AKI = Direct kidney damage</p> Signup and view all the answers

List three common causes of prerenal AKI.

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

High urine osmolality is commonly associated with postrenal AKI.

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

Which of the following is a common cause of postrenal AKI?

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

In intrinsic/intrarenal AKI, __________ injury leads to inflammation, casts blocking urine flow, and backleak of filtrate.

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

What is the most common cause of Intrinsic/Intrarenal AKI?

<p>Acute Tubular Necrosis (ATN) (D)</p> Signup and view all the answers

Flashcards

Anemia

Reduced number of red blood cells or hemoglobin in the blood, leading to decreased oxygen-carrying capacity.

Renal Osteodystrophy

Bone disease that occurs in patients with chronic kidney disease due to disturbances in calcium and phosphorus metabolism.

Hypertension

High blood pressure; a common condition where the force of the blood against artery walls is too high.

Azotemia/Uremic Syndrome

Accumulation of nitrogenous waste products (such as urea and creatinine) in the blood. Uremia includes azotemia plus clinical signs and symptoms.

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Electrolyte Imbalance

An imbalance in the concentration of electrolytes (such as sodium, potassium, calcium) in the body.

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Metabolic Acidosis

An acid-base imbalance characterized by an excess of acid in the body fluids.

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Depression

A mood disorder causing persistent feeling of sadness and loss of interest.

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Potassium & Cardiac Arrest

High levels of potassium in the blood can lead to life-threatening cardiac arrest/death.

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Anemia in ESRD

Reduced erythropoietin production by the kidneys leads to a decrease in red blood cell (RBC) production.

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Uremia's effect on RBCs

Uremia, a condition associated with kidney failure, shortens the lifespan of RBCs.

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Renal Osteodystrophy Cause

A bone disease in end-stage renal disease (ESRD) resulting from the kidneys' inability to regulate calcium and phosphorus levels, leading to weakened bones.

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Role of PTH in Renal Osteodystrophy

High phosphorus and low calcium levels stimulate increased parathyroid hormone (PTH) secretion, resulting in bone breakdown.

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Chronic Kidney Disease

Progressive and irreversible loss of nephron function in the kidneys.

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Pyelonephritis

An infection of the kidney, often caused by bacteria ascending from the urinary tract.

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Glomerulonephritis

Inflammation of the glomeruli, the filtering units in the kidneys.

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Polycystic Kidney Disease

A genetic disorder characterized by the growth of numerous cysts in the kidneys.

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Diabetes and CKD

Elevated blood sugar levels, which can damage various organs, including the kidneys.

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Prodromal Phase of ATN

The initial phase of Acute Tubular Necrosis with mild symptoms, normal or decreased urine output, and rising serum BUN and creatinine levels. The duration depends on severity.

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Oliguric Phase of ATN

A phase of Acute Tubular Necrosis characterized by severe kidney dysfunction, urine output dropping to 50-400 mL/day, fluid retention, hyperkalemia, and uremia. It can last 1-8 weeks and dialysis may be required.

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Postoliguric Phase of ATN

The recovery phase of Acute Tubular Necrosis where the kidneys start recovering, leading to increased urine output (diuresis phase). It may last weeks to a year.

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Acute Tubular Necrosis (ATN)

Cell death in the renal tubules due to insufficient blood supply.

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Ischemia

Reduced blood flow leading to tissue damage or death.

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Ischemia's Role in ATN

Ischemia reduces oxygen in kidney cells, causing damage.

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Prerenal AKI

AKI due to decreased blood flow to the kidneys.

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Causes of Prerenal AKI

Common causes include hypovolemia, hypotension, heart failure, renal artery obstruction, burns, dehydration, NSAIDs, and ACE inhibitors.

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Postrenal AKI

AKI caused by obstruction of urine flow.

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Causes of Postrenal AKI

Kidney stones, tumors, or an enlarged prostate.

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Intrinsic/Intrarenal AKI

AKI caused by direct damage to the kidney tissue.

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Causes of Intrinsic AKI

Infections, toxins, ischemia, contrast media, or sepsis.

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Prerenal AKI Indicators

Reduced GFR, oliguria, and high urine osmolality.

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Prerenal AKI consequence

Prolonged prerenal injury can escalate to this condition.

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Postrenal AKI Effect

Obstruction leads to increased pressure in kidneys, resulting in this.

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Study Notes

  • Ischemia leads to acute tubular necrosis.

Types of Acute Kidney Injury

  • Prerenal AKI relating to CSlides 7-8 is caused by reduced kidney perfusion.
    • Common causes of Prerenal AKI include: hypovolemia, hypotension, heart failure, renal artery obstruction, burns, dehydration, NSAIDs, and ACE inhibitors.
    • Manifestations include low GFR, oliguria, and high urine osmolality.
    • Prolonged prerenal injury can lead to acute tubular necrosis.
  • Postrenal AKI relating to CSlide 9 is caused by obstruction of urine flow.
    • Example causes include kidney stones, tumors, and an enlarged prostate.
    • Backflow increases pressure in the kidneys, leading to glomerular filtration impairment.
    • Prolonged postrenal AKI can lead to ATN and irreversible kidney damage.
  • Intrinsic/Intrarenal AKI relating to CSlides 10-11 is caused by direct kidney damage.
    • Example causes include infections, toxins, ischemia, contrast media, and sepsis.
    • The most common cause is acute tubular necrosis.
    • Two mechanisms of Intrinsic/Intrarenal AKI include:
      • Vascular injury which causes decreased blood flow, hypoxia, and vasoconstriction.
      • Tubular injury which causes inflammation, casts blocking urine flow, and backleak of filtrate.

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