Flashcards in Chronic Kidney Disease Deck (12):
1
What is a chronic kidney disease?
An umbrella term describing a large spectrum of diseases
Abnormalities/ damage to the kidney structure present for more than 3 months
2
What are the ways to diagnose CKD?
Kidney structure - kidney biopsy
Kidney function - GFR < 60 ml/min/1.73m2
Damage biomarkers
3
What are the causes of CKD?
Idiopathic - unknown
Hypertension
Diabetic nephropathy
IgA nephropathy
4
What is a common feature of CKD following treatment of the underlying cause?
Even after a cause of CKD has been treated - kidney function continues to decline as they scar over time
5
Pathogenesis of CKD
1. Glomerulus becomes damaged
2. Since the glomerulus supplies the tubules -> nephrons become damaged and ischaemic
3. This triggers inflammation - deposition of collagen
4. Cells around the tubule change phenotype - become more fibrotic = interstitial fibrosis
5. Loss of ischaemic nephron is buffered by the rest of the kidney
6. Blood supply to the healthy nephrons increases
7. Proteins leak from the blood to the tubule = proteinuria
8. Increased P in the glomeruli damages the blood tubules
9. Proteins in tubules change phenotype to inflammatory proteins
10. Infiltration of inflammatory cellls and pro-fibrotic changes in the cells that make up the interstitium = fibrosis
11. Loss of nephrons
12. Cycle of fibrosis and worsening scarring
6
What is the main feature of chronic kidney failure?
Irreversible depletion of nephrons
7
How to treat CKD
Treat the underlying disorder
Control blood sugar levels in patients
Immunosuppression in glomerulonephritis
8
What is a system that is often targeted in the treatment of CKD?
Renin-angiotensin system
9
What does the renin-angiotensin normally cause?
Vasoconstriction
10
Which drugs target the renin-angiotensin system?
Renin inhibitor
ACE inhibitor
Angiotensin 2 receptor blocker
11
Why is the renin-angiotensin system the best system to target in order to reduce renal BP?
Specific to for glomerular pressure
Only affects the kidney
12