654
U N I T 7
Kidney and Urinary Tract Function
R E V I EW E X E R C I S E S
1.
A 55-year-old man with diabetes and coronary
heart disease, who had undergone cardiac
catheterization with the use of a radiocontrast
agent 2 days ago, is admitted to the emergency
department with a flulike syndrome including
chills, nausea, vomiting, abdominal pain, fatigue,
and pulmonary congestion. His serum creatinine
is elevated, and he has protein in his urine. He
is admitted to the intensive care unit with a
tentative diagnosis of acute kidney injury due to
radiocontrast nephropathy.
A.
Radiocontrast agents are thought to exert
their effects through decreased renal perfusion
and through direct toxic effects on renal
tubular structures. Explain how each of these
phenomena contributes to the development of
acute kidney injury.
B.
Explain the elevated serum creatinine,
proteinuria, and presence of pulmonary
congestion.
2.
A 35-year-old, 70-kg white man with diabetes
mellitus is seen in the diabetic clinic for his
6-month check-up. His serum creatinine, which
was slightly elevated at his last visit, is now
1.6 mg/dL.
A.
Use the following website to estimate his GFR:
/
gfr_calculator.cfm
B.
Would he be classified as having chronic kidney
disease? If so, what stage? What might be done
to delay or prevent further deterioration of his
kidney function?
3.
Chronic kidney disease is accompanied by
hyperphosphatemia, hypocalcemia, impaired
activation of vitamin D, hyperparathyroidism, and
skeletal complications.
A.
Explain the impaired activation of vitamin D
and its consequences on calcium and phosphate
homeostasis, parathyroid function, and
mineralization of bone in persons with CKD.
B.
Explain the possible complications of the
administration of activated forms of vitamin
D on parathyroid function and calcium and
phosphate homeostasis.
R E F E R E N C E S
1. Rahman M, Shad F, Smith MC. Acute renal injury: a
guide to diagnosis and management.
Am Fam Physician.
2012;86(7):631–639.
2. Kellum JA, Lameire N; for the KDIGO Guideline Work Group.
Diagnosis, evaluation, and management of acute kidney injury: a
KDIGO summary (Part 1).
Crit Care.
2013;17:204, 1–15.
3. Martin RK. Acute kidney injury.
AACN Adv Crit Care.
2010;21(6):350–356.
4. Belloma R, Kellum JA, Ranco C. Acute kidney injury.
Lancet.
2012;380:756–766.
5. Khalil P, Murty P, Palevsky PM. The patient with acute renal
injury.
Prim Care.
2008;35:239–264.
6. Zarjou A, Agarwal A. Sepsis and acute kidney injury.
J Am Soc
Nephrol.
2011;22:999–1006.
7. Abuelo JG. Normotensive ischemic acute renal failure.
N Engl J
Med.
2007;357(8):797–805.
8. Hall JE.
Guyton and Hall Textbook of Medical Physiology
.
12th ed. Philadelphia, PA: Saunders Elsevier; 2011:399–410.
9. Jennette JC. The kidney. In: Rubin R, Strayer DS. eds.
Rubin’s
Pathology: Clinicopathologic Basis for Medical Practice
. 6th ed.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2012:791–794.
10. Alpers CE. The kidney. In: Kumar V, Abbas AK, Fausto N,
eds.
Robbins and Cotran Pathologic Basis of Disease
. 8th ed.
Philadelphia, PA: Saunders Elsevier; 2010:935–938.
11. McCullough PA, Soman SS. Contrast-induced nephropathy.
Crit
Care Clin.
2005;21:261–280.
12. Tolwani A. Continuous renal-replacement therapy for acute
kidney injury.
N Engl J Med.
2012;367(26):2505–2514.
13. Chonchol M, Chan L. Chronic kidney disease: manifestations
and pathogenesis. In: Schrier RW, ed.
Renal and Electrolyte
Disorders
. 7th ed. Philadelphia, PA: Wolters Kluwer Health/
Lippincott Williams & Wilkins; 2010:389–425.
14. Levey AS. Chronic kidney disease.
Lancet.
2012;379:165–180.
15. Murphree DD, Thelen SM. Chronic kidney disease in primary
care.
J Am Board Fam Med.
2010;23(4):542–550.
16. Baumgarten M, Gehr T. Chronic kidney disease: detection and
evaluation.
Am Fam Physician.
2011;84(10):1138–1148.
17. National Kidney Foundation. Chronic kidney disease—a growing
problems. 2013. Available at:
factsheets/CKD-A-Growing problem. Accessed July 4, 2013.
18. National Kidney Foundation. KDOQI clinical practice guidelines for
chronic kidney disease: evaluation, classification, and stratification.
2002. Available at:
guidelines_ckd/toc.htm. Accessed July 30, 2013.
19. Levey AS, Eckardt KW, Tsukamato Y. Definition and
classification of chronic kidney disease: a position statement from
kidney disease: improving global outcomes (KDIGO).
Kidney
Int.
2005;67:2089–2100.
20. Stevens LA, Coresh J, Greene T, et al. Assessing kidney function:
measured and estimated glomerular filtration rate.
N Engl J Med.
2006;354:2473–2483.
21. Eknoyan G, Hostetter T, Barkis GL, et al. Proteinuria and other
markers of chronic kidney disease: a position statement of the
National Kidney Foundation (NKF) and the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK).
Am J
Kidney Dis.
2003;42:617–622.
22. Aimeras C, Argilés Á. The general picture of uremia.
Semin Dial.
2009;22(4):329–333.
23. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its
complications.
Prim Care.
2008;35:329–344.
24. Watnick S, Dirkx T. Kidney disease. In: Papadakis MA, McPhee
SJ, eds.
Current Medical Diagnosis and Treatment
. New York,
NY: McGraw-Hill Lange; 2013:908–917.
25. Tsimihodimos V, Dounousi E, Siamopoulos KC. Dyslipidemia
in chronic kidney disease: an approach to pathogenesis and
treatment.
Am J Nephrol.
2008;28:958–973.
26. Schiffrin EL, Lipman ML, Mann JFE. Chronic kidney disease:
effects on cardiovascular function.
Circulation.
2007;116:85–97.
27. Eknoyan G, Levin NW. Bone metabolism and disease in chronic
kidney disease.
Am J Kidney Dis.
2003;42(suppl 3):S1–S201.
28. National Kidney Foundation Inc. KDOQI clinical practice
guideline for bone metabolism and disease in chronic kidney
disease.
Am J Kidney Dis.
2003;42(suppl 3):S1–S202.
