3: Chronic Renal Failure

Question 0

Chronic Kidney Disease (CKD)- 6 phases

Answer 0

0: Normal kidney GFR: 120-90
1: Diseased kidney GFR: 120-90
2: Kidney disease with mild reduction in GFR GFR: 90-60
3: ““with Moderate “” GFR: 60-30
4: ““GFR: 30-15
5: ESRD GFR: <15
CRF: GFR is less than 60mm/min/1.73m2BSA (body surface area)

Question 1

Chronic Renal Failure- definition

Answer 1

Progressive and Irreversible
Chronic reduction in GFR
Accumulation of Nitrogenous waste that affect multiple organs

Question 2

CRF Ddx Acute

Answer 2

Small shrunk kidney
Anemia
Osteodystrophy (bone deformity)
Proteinuria

*Bid kidney with CRF: Polycystic kidney disease, Diabetic nephrosis

Question 3

MCC of CRF

Answer 3

1: Diabetes
2: HTN
3: Polycystic kidney disease

Question 4

Electrolytes- CFR

Answer 4

Hypothermia (Na/K pump is dysfunctional, thus cannot use the pump to increase the body temp)
Metabolic acidosis
Hyperkalemia
Hyperphosphatemia
Hypocalcimia (causes increase in PTH and bone deformation)

Question 5

Hormones-CRF

Answer 5

Increase:
PTH
LH/Prolactin (reduced level of testosterone and estrogen)
Insulin (kidney cannot break it down) 
Decrease:
Estrogen/ Testosterone (toxin build up)
EPO
1,25-(OH)2-D3

Question 6

Protein/Fat/Carbs- CRF

Answer 6

Protein- Depleted
1: renal loss
2: reduced intake
3: acidosis/ Toxin (ubiquitin, proteasome) depletes protein
Fat- Atherogenic Fat is higher (high LDL, triglycerides)
Carbs- Hypoglycemia (high insulin)
*if it is non-diabetic cause of CRF, increased peripheral insulin resistance: pseudo-diabetes**

Question 7

General appearance-CRF

Answer 7

Skin- pale, bruising, achemosis, Uremic frost (deposition of toxin on skin), Uremic breath (ammonia in mouth), Urochroms (dark pigmentation)

Question 8

Neurological sx-CRF

Answer 8

Central-
Early- confusion, sleep disturbance 
Late- cramps, hiccups* (neuromuscular)
Severe- encephalopathy
Peripheral- restless leg syndrome (tx: clonazepam)
Distal > proximal
Lower limb>Upper limb
Sensory>motor
ANS-

Question 9

Musculoskeletal sx- CRF

Answer 9

Muscle-
Wasting
Weakness
Bone- renal osteodystrophy
Osteopenia-> Osteoporosis (low estrogen)
Osteomalacia: defective mineralization (vitD deficiency)
Osteitis fibrosa cystica: High turnover-> empty space-> brown cyst

Question 10

GI sx-CRF

Answer 10

Gastritis, Pancreatitis, Hepatitis, etc
Bleeding
Nausea
Vomiting

Question 11

Cardio sx-CRF

Answer 11

CHF
Calcification of vessels
Cardiac effusion
etc

Question 12

Imaging

Answer 12

U/S- size of kidney
Dextrose scan: bone density
Bx: amyloidosis
PT, PTT

Question 13

Management

Answer 13

Stop the insult
Electrolyte tx
symptomatic tx
Renal replacement tx
-Dialysis (Hemo or Peritoneal)
-Transplantation