12.7 Chronic Renal Failure

Question 1

How does uremia affected clotting?

Answer 1

Uremia inhibits platelet adhesion and aggregation

Question 2

where is EPO made? be specific

Answer 2

Renal peritubular interstitial cells

Question 3

what heart complication can uremia cause?

Answer 3

percarditis

Question 4

What complicaiton does uremia have on the brain? What is the clinical sign?

Answer 4

encephalopathy (damage to neurons), with asterixis–tremor of hand when wrist extended

Question 4

what complication of dialysis increases risk of renal cell carcinoma?

Answer 4

growth of cysts in kidneys on dialysis

Question 6

Uremia: what symptoms (6)

Answer 6

increased nitrogenous waste products in blood (azotemia):

1. nausea
2. anorexia
3. pericarditis
4. platelet dysfunction (uremia inhibits platelet adhesion and aggregation)
5. encephalopahty with asterixis
6. urea crystal deposition in skin

Question 7

Chronic renal failure: effect on calcium levels. Why?

Answer 7

hypocalcemia

1. decreased 1-OH of Vit D by kidneys, so less abosrption of Ca
2. hyperphosphatemia means more phosphate binds free Ca

Question 8

What skin complication does uremia have?

Answer 8

Urea crystal deposition in skin

Question 9

what complication often happens to shrunken kidneys that undergo dialysis?

Answer 9

Development of cysts. increase risk for renal cell carcinoma

Question 10

what happens to blood composition in chronic renal failure?

Answer 10

anemia, from loss of EPO

Question 11

3 most common causes of end stage renal failure

Answer 11

1. DM2
2. HTN
3. glomerular disease

Question 12

Chronic renal failure:

clinical presentation (all 8!)

Answer 12

MR CA PUNK

1. metabolic acidosis (nephrons unable to remove fixed acid from daily protein catabolism, so put pts on low protein diet)
2. renal osteodystrophy (osteitis fibrosa cystica–secondary hyperparathyroidism from hypocalcemia)
3. Ca: hypocalcemia–from 1) low 1,25 Vit D b/c kidney provides 1-OH step, and 2) increased phosphate binds Ca
4. Anemia–from low EPO
5. Phosphate: hyperphosphatemia–nephrons cannot excrete
6. Uremia–azotemia
7. Na retention–edema, HTN
8. K–hyperkalemia, nephrons cannot excrete.