Hypertension and Kidney Disease Quiz
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Questions and Answers

What is a characteristic sign that may indicate secondary hypertension?

  • High blood pressure before age 30 (correct)
  • Normal systolic pressure under 120
  • Low body mass index
  • Controlled blood pressure with medication

Which of the following diseases is NOT commonly associated with causing secondary hypertension?

  • Polycystic kidney disease
  • Asthma (correct)
  • Diabetes
  • Cushing syndrome

What factor differentiates primary hypertension from secondary hypertension?

  • Age of onset
  • Family history of hypertension
  • Response to lifestyle changes
  • Presence of underlying disease (correct)

Which medication class is known to potentially contribute to secondary hypertension?

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

Which of the following is a common contributing factor to primary hypertension?

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

What is the primary requirement for a diagnosis of chronic kidney disease?

<p>Presence of kidney damage for at least three months (C)</p> Signup and view all the answers

In the testing for kidney disease, which lab result would primarily indicate a risk for chronic kidney disease?

<p>Urine protein to creatinine ratio above 30 milligrams per gram (D)</p> Signup and view all the answers

What stage of chronic kidney disease is characterized by a GFR less than 60?

<p>Stage 3 (A)</p> Signup and view all the answers

Which of the following conditions is characterized by a significant amount of protein in the urine?

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

Which demographic is at a significantly increased risk for developing kidney failure?

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

What is an indicator that a patient's kidney function may not be considered normal?

<p>GFR less than 60 (D)</p> Signup and view all the answers

What is the recommended urine albumin level indicative of potential kidney disease?

<p>More than 30 milligrams per gram (C)</p> Signup and view all the answers

What is a common risk factor that should be included in the comprehensive health history for testing chronic kidney disease?

<p>Family history of autoimmune diseases (A)</p> Signup and view all the answers

What possible complication can a simple kidney cyst cause?

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

Which of the following is NOT a cause of having a solitary kidney?

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

What is a primary management strategy for chronic kidney disease?

<p>Regular screening for risk factors (A)</p> Signup and view all the answers

When caring for a patient with chronic kidney disease, which medication usage warrants caution?

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

Which condition is associated with amyloidosis?

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

What is a significant consideration for nephrology visits?

<p>Managing blood pressure in coordination with cardiology (C)</p> Signup and view all the answers

Which dietary plan is recommended for patients concerned about kidney health?

<p>DASH eating plan (A)</p> Signup and view all the answers

During an acute elevated creatinine situation, which is a critical step in management?

<p>Watch kidney function weekly (B)</p> Signup and view all the answers

What kind of testing should a person with a solitary kidney undergo regularly?

<p>Urine tests for albuminuria (B)</p> Signup and view all the answers

Which symptom is associated with chronic kidney disease that a primary care provider should watch for?

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

Which condition is primarily caused by autoantibodies forming in the glomeruli?

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

What is the leading cause of kidney failure among American Indians?

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

Which of the following is NOT a common sign of glomerular disease?

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

What genetic disorder is the most common form of polycystic kidney disease?

<p>Autosomal dominant polycystic kidney disease (A)</p> Signup and view all the answers

Renal artery stenosis is primarily caused by which condition?

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

Which condition is characterized by the deposition of immunoglobulin IgA in the glomeruli?

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

At what age does Autosomal dominant polycystic kidney disease typically present symptoms?

<p>Between ages 30 and 50 (A)</p> Signup and view all the answers

What is a common treatment method for renal artery stenosis?

<p>Surgery, medications, and lifestyle changes (A)</p> Signup and view all the answers

Which disease primarily affects young men and involves an autoantibody targeting the kidneys and lungs?

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

Which condition is associated with both auditory and visual impairments in men?

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

What role does calcitriol serve in kidney function?

<p>It promotes the absorption of calcium and bone formation. (B)</p> Signup and view all the answers

Which dietary change is recommended for patients in stages 4 and 5 of chronic kidney disease?

<p>Limit or exclude foods high in phosphorus such as cheese and nuts. (A)</p> Signup and view all the answers

What common complication arises due to a deficiency of EPO in patients with kidney disease?

<p>Anemia due to reduced red blood cell production. (B)</p> Signup and view all the answers

What is a primary consequence of high levels of phosphorus in the blood for patients with chronic kidney disease?

<p>Calcium being pulled out of bones, leading to osteoporosis. (A)</p> Signup and view all the answers

Which of the following medications is commonly used in stage 4 CKD to manage vitamin D levels?

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

What symptom may indicate end-stage renal disease?

<p>Fluid retention and swelling in extremities. (D)</p> Signup and view all the answers

During dialysis, which of the following electrolytes is typically adjusted?

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

What form of dialysis involves using a machine at night while the patient sleeps?

<p>Automated peritoneal dialysis. (D)</p> Signup and view all the answers

What are phosphate binders used for in patients with CKD?

<p>To bind phosphate in the bowels and prevent absorption. (C)</p> Signup and view all the answers

What is generally avoided in the diet for patients with phosphorus regulation issues in stages 3 and 4?

<p>High phosphorus foods. (B)</p> Signup and view all the answers

Flashcards

What is chronic kidney disease?

Kidney damage lasting at least 3 months, characterized by structural or functional abnormalities. This includes reduced GFR (glomerular filtration rate) and abnormal blood or urine composition.

What is GFR?

A measure of how well your kidneys filter waste from your blood. A GFR less than 60 for at least 3 months, with or without kidney damage, indicates CKD.

What are the stages of CKD?

Stages 1 through 5 categorize the severity of CKD based on GFR and presence of kidney damage. Stage 1 has the highest GFR and stage 5 has the lowest.

What's the first step in CKD testing?

A comprehensive health history is essential to identify risk factors, such as diabetes, hypertension, family history, and autoimmune diseases, for CKD.

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What lab tests help diagnose CKD?

Tests like urine albumin, urine protein-to-creatinine ratio, and comprehensive metabolic panel provide insights into kidney health.

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What is nephrotic syndrome?

A condition with very high levels of protein in urine, leading to low blood protein, swelling, and high cholesterol.

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How does race impact CKD?

African Americans are at a significantly higher risk of developing kidney failure compared to Caucasians.

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What does the urine protein-to-creatinine ratio indicate?

Higher protein levels in urine (above 30 milligrams per gram) may indicate kidney damage. Normal levels are 30 milligrams per gram or less.

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Diabetes and Hypertension

A leading cause of kidney failure in the US, impacting both Americans and Hispanics. This chronic condition is characterized by high blood sugar levels, affecting the kidneys' ability to function optimally.

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Polycystic Kidney Disease (PKD)

A genetic disorder where many cysts grow in the kidneys. It can lead to kidney failure due to impaired kidney function.

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Lupus Nephritis

A type of kidney disease caused by lupus, an autoimmune disorder that attacks the body's own tissues.

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Goodpasture Syndrome

A rare autoimmune disorder that affects the kidneys and lungs. Characterized by antibodies attacking these organs, it can cause kidney failure and breathing difficulties.

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IgA Nephropathy

A form of glomeruli disease where immunoglobulin IgA deposits in the glomeruli causing inflammation. It can lead to blood in the urine and kidney damage.

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Alport Syndrome

A genetic disorder affecting the kidneys, hearing, and vision. It's often inherited and can cause kidney failure.

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Renal Artery Stenosis (RAS)

A narrowing of one or both renal arteries, often caused by atherosclerosis. It can reduce blood flow to the kidneys, leading to kidney disease.

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Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A genetic disorder that causes fluid-filled cysts to grow in the kidneys. It's more common in adults and can lead to kidney failure.

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Autosomal Recessive Polycystic Kidney Disease (ARPKD)

A rare genetic disorder that causes fluid-filled cysts in the kidneys, affecting newborns and infants. It can lead to poor kidney function.

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Simple Kidney Cysts

Fluid-filled sacs in the kidneys. These are mostly harmless and don't significantly affect kidney function.

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What is a solitary kidney?

A condition where an individual has only one functional kidney.

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What are amyloid proteins?

Abnormal proteins that build up in tissues and organs, causing various symptoms.

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What are key aspects of managing a solitary kidney?

Regularly monitoring urine for albumin, performing CMP/BMP blood tests, and managing blood pressure.

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What's the primary focus in managing CKD?

The primary way to manage chronic kidney disease, by addressing the underlying cause.

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Who is a nephrologist?

A specialist dealing with kidney diseases.

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What are essential aspects of CKD management by a PCP?

Frequent monitoring of blood pressure, medication adjustments, and avoiding nephrotoxic substances.

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What are some key responsibilities of a nephrologist in CKD management?

Managing blood pressure, mineral and bone disorders, anemia, dialysis preparation, and educating patients about CKD.

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How is CKD co-managed between a PCP and a nephrologist?

Working collaboratively with the nephrologist on aspects like diet, exercise, and medications.

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What is an acute elevated creatinine?

An elevated creatinine level, indicating possible kidney problems.

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Describe the DASH diet.

A low-fat, low-cholesterol diet rich in fruits, vegetables, and whole grains, ideal for kidney health.

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Vitamin D and CKD

Healthy kidneys activate vitamin D into calcitriol, which helps maintain calcium levels and bone formation.

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Calcitriol Deficiency in CKD

When kidneys fail, they can't activate vitamin D properly, leading to low calcitriol levels and calcium imbalance.

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Hyperphosphatemia and Bone Health

High phosphorus levels in the blood (hyperphosphatemia) pull calcium out of the bones, weakening them.

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Phosphorus-Rich Foods

Foods high in phosphorus should be limited or avoided in CKD, especially in later stages.

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CKD Medications

Medications like ergocalciferol, calcifar, and calcitriol are used to manage calcium and phosphorus levels in CKD.

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Phosphate Binders

Phosphate binders, like calcium carbonate, calcium acetate, Renvela, or lanthanum carbonate, bind phosphorus in the gut.

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Anemia in CKD

Kidney disease can lead to anemia due to decreased production of EPO (erythropoietin), which stimulates red blood cell formation.

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Nutrients for Red Blood Cell Production

Iron, vitamin B12, and folic acid are essential for red blood cell production and can be depleted in CKD.

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End-Stage Renal Disease (ESRD)

End-stage renal disease (ESRD) is kidney failure requiring dialysis or transplant.

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ESRD Symptoms

ESRD symptoms include swelling, headaches, fatigue, nausea, itching, weight loss, and urinary changes.

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Secondary Hypertension

High blood pressure that doesn't respond to medication or has a sudden onset.

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Unusual Onset Hypertension

High blood pressure that develops before age 30 or after age 55, especially if there's no family history or obesity.

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Aldosteronism

A condition where the adrenal glands produce too much aldosterone, a hormone that regulates blood pressure.

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Glomerular Diseases

A group of diseases affecting the tiny blood vessels in the kidneys, leading to high blood pressure.

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Coarctation of the Aorta

A narrowing of the aorta, the main artery carrying blood from the heart, which can cause high blood pressure.

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Study Notes

Chronic Kidney Disease (CKD) Overview

  • CKD is kidney damage lasting ≥3 months, defined by structural or functional abnormalities.
  • This can be through pathologic abnormalities, markers of damage, abnormal blood/urine composition, or imaging abnormalities.
  • GFR < 60 or GFR ≥ 60 for ≥ 3 months with or without kidney damage are key definitions.
  • Over 30 million American adults have CKD.

CKD Stages

  • Five stages of CKD are depicted in the provided image.
  • The stages are defined by the presence/absence of kidney damage, high blood pressure, and normal/abnormal kidney function.

CKD Testing and Diagnosis

  • Comprehensive health history taking is crucial, including risk factors, family history, and pre-existing conditions (diabetes, hypertension).
  • Important lab tests include a comprehensive metabolic panel, urinalysis, urine albumin/protein to creatinine ratio.
  • A ratio of 30 mg/g or less is considered normal; >30 mg/g could indicate kidney disease.
  • Nephrotic syndrome presents with high urine protein, low blood protein, swelling, and high cholesterol.

CKD Causes

  • Leading causes in the US are diabetes and hypertension.
  • Other causes include polycystic kidney disease, infections, nephrotoxic drugs, systemic diseases (like lupus nephritis), immune system disorders (Goodpasture syndrome), heavy metal poisoning, rare genetic conditions (Alport syndrome), and renal artery stenosis.

CKD Management across Stages

  • Management in primary care includes screening, annual labs, timely nephrologist referral.
  • Watch for weight changes, edema, appetite/fatigue changes in CKD stage 4 patients.
  • Limit or eliminate NSAIDs in CKD stages 3, 4, and 5.
  • Closely monitor blood pressure (including hypotension) and dose-adjust medications based on GFR.
  • Avoid nephrotoxic medications, particularly CT contrast.

CKD: Follow-up and Co-management

  • Nephrologists manage blood pressure, mineral/bone disorders, vitamin D, calcium, parathyroid, and anemia.
  • Collaboration with hematologists/oncologists for anemia.
  • Dialysis preparation, Kidney Smart classes, and dialysis option classes are important.
  • Follow-up intervals vary, depending on CKD progression and stage.
  • Primary care physicians manage diet, exercise, and medications, especially for those in CKD stages 1-2.

Acute Kidney Injury (AKI) Suspicion

  • In patients with acute elevated creatinine, investigate acute illnesses, dehydration, new medications, and NSAID overuse.
  • Monitor kidney function weekly if necessary. Referral to nephrology or inpatient workup could be required.
  • If AKI is suspected and on ACE/ARB therapy, hold medications to allow function to return to normal as the patient is monitored.

CKD: Diet and Exercise

  • DASH diet is a good general guideline in CKD.
  • Includes: low-fat/low-cholesterol foods, fat-free/low-fat dairy, fish, poultry, & nuts; and less red meats, sweets, and added sugars.
  • Regular physical activity, BMI reduction, smoking cessation.
  • Stress reduction.

CKD Mineral and Bone Disorders

  • Damaged kidneys and hormone imbalances cause calcium/phosphorus imbalances.
  • Healthy kidneys activate vitamin D (calcitriol) for calcium regulation and phosphorus clearance.
  • CKD disrupts this process, leads to low calcitriol, high phosphorus levels, and calcium depletion of the bone, potentially causing osteoporosis and joint damage.
  • High levels of calcium and phosphorus can deposit in blood vessels, affecting cardiovascular health. Usually, that's seen after CKD stage 3b, 4, and 5.

CKD: Stage-Specific Dietary/Medications

  • Dietary changes for stages 4 and 5 include limiting high-phosphorus foods (certain beers, cheeses, etc.).
  • Medications: Stage 3 might include ergocalciferol, calcitriol supplements in stage 4 for calcium absorption and PTH regulation, and perhaps eventually IV calcitriol/other medications in stage 5 and dialysis.
  • Phosphate binders (e.g., calcium carbonate, calcium acetate, Renvela, lanthanum carbonate) are used to manage phosphorus.

CKD Anemia

  • CKD leads to reduced erythropoietin (EPO) production from diseased kidneys, resulting in less red blood cell production.
  • Other causes include blood loss from dialysis and nutritional deficiencies (iron, vitamin B12, folic acid).
  • Treatment may include EPO injections and iron supplements.
  • First intervention includes dietary adjustments, if further increase is needed or the diet is not enough, IV or oral supplements are necessary.

End-Stage Renal Disease (ESRD)

  • ESRD is treated with dialysis or kidney transplant.
  • Watch for swelling, headaches, itching, fatigue, nausea, taste changes, loss of appetite, low urine output, muscle cramps, weakness, joint pain/stiffness/fluid, confusion, and memory problems.
  • Associated issues include hypertension, heart disease, anemia, mineral/bone disorders, malnutrition.
  • Treatment emphasizes balanced diet, phosphate binders, and dialysis adherence.

Hemodialysis vs. Peritoneal Dialysis

  • Hemodialysis uses diffusion, convection, and osmotic pressure to remove waste products and electrolytes (sodium, calcium, bicarbonate, potassium) and fluid.
  • Peritoneal dialysis uses a sugar (dextrose or icodextrin) in a dialysis solution to remove waste and fluid from the blood into the abdomen.
  • Continuous cycling and continuous ambulatory peritoneal dialysis are options.

Secondary Hypertension in CKD

  • Primary hypertension is linked to genetics, diet, exercise, and obesity.
  • Secondary hypertension may stem from conditions like diabetes, polycystic kidney disease, glomerular diseases, renovascular hypertension, Cushing syndrome, aldosteronism, thyroid/parathyroid disease, coarctation of the aorta, sleep apnea, pregnancy, medications, and supplements.
  • Watch out for signs of secondary hypertension needing further investigation by a specialist. It's important to investigate and treat it.

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Description

Test your knowledge on the characteristics and differences between primary and secondary hypertension, as well as the diagnosis and risk factors associated with chronic kidney disease. This quiz covers various conditions, medications, and laboratory results crucial for understanding these health issues.

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