19: Care of Renal Patient - Thompson

Question 1

volume and renal artery stenosis are classified as…

Answer 1

prerenal failure

Question 2

3 main causes chronic renal failure

Answer 2

DM
HTN
Inflammation (post-strep)

Question 3

*** risk factors renal disease

Answer 3

DM
smoking
HTN
obesity
cholesterol
African/Eastern
FMHx
greater than 65 yo

Question 4

*** how is renal disease connected to LE?

Answer 4

• muscle infarct
• osteoporosis/osteopenia
• poor micorcirculation
• increased FX risk
• tendon rupture
• ESRD - amputation 10x risk (2/3 of these amps die w/i 1st yr)

Question 5

*** what changes in bone are seen with renal disease?

Answer 5

• phosphorus and calcium INVERSELY related
• RF leads to HIGH Ph
• Pulls calcium out of the bone

Question 6

what can you do as doctors to protect pt’s kidneys?

Answer 6

• prevent hypotnsionduring surgery
• prevent hypovolemia
• avoid nephrotoxic medicines
• encourage HTN and DM tx compliance
• encourage to quit smoking

Question 7

*** Meds that clear slowly with RF

Answer 7

insulin
narcotics
benzos
some ABX (fluorquinolone)

Question 8

why does contrast hurt kidneys and what can we do about it?

Answer 8

unclear - hypoperfusion or direct toxicity
there is a higher risk in the already compomised or taking nephrotoxic drugs or dehydrated

observed 48 hr post contrast

hyrdate the pt; pr-med with mucomyst

stop metformin 2 days past contrast (can stop prior if know before-hand)

Question 9

dialysis risk for fractures?

Answer 9

52% had low trauma fractures

69% has osteopenia

Question 10

summary

Answer 10

be protective of kidneys
monitor their function
treat renal pt similarly to diabetics
be aware of medicines and renal function