90 End Stage Renal Disease Flashcards
What is the clinical syndrome that results from SRD that is fatal without renal replacement therapy?
Uremia
What is the difference in esrd initial treatment in children versus adults?
Hemal dialysis is the initial therapy and most new cases of adult he SRD with some starting peritoneal dialysis and a few receiving renal transplant’s. But kids mostly receive transplants first.
One year and five year mortality for hemodialysis patients
20 to 25%, and 35% respectively
What toxins are elevated in uremia?
In addition to urea, other potentially remake toxins include sign it, quantity, polyamines, and better to microglobulin.
Why does dialysis not reverse all problems associated with uremia and excretory failure?
Because many toxins are highly protein bound and non-dialyzable. This is an entire toxidrome
Explain with biosynthetic failure is
This is the aspect of uremia and kidney disease associated with the loss of the biosynthetic functions of one alpha hydroxylase an EPO. Thus we cannot make enough vitamin D activated form or RBC
Explain secondary hyperparathyroidism?
This is because vitamin D deficiency results and decrease G.I. calcium absorption so then our bodies activate parathyroid hormone to increase calcium. Also there is a loss of excretion of phosphate. And PTH is the phosphate excreting hormone. Thus elevated PTH miss osteitis cystic fibrosis
Explain regulatory failure in and stage renal disease?
This is atherosclerosis and amyloidosis an ESRD patients because your email leads to destruction of normal Feedback, production of free oxygen radicals create advanced glycation end products
What determines the decision to start long-term dialysis?
Really it’s the patient’s symptoms related to your email. BUNCM creatinine levels are in accurate markers at the clinical syndrome of uremia.
Name the neurologic complications of Uremia
Uremic and cephalopathy, stroke, dialysis dementia, peripheral neuropathy
Why are troponins tricky in end-stage renal disease?
Troponin I and T elevations are common even an asymptomatic hemodialysis patients. However it is also associated with long-term risks of coronary artery disease. Many define am I only buy a value greater than 99 percentile
What are the major cardiac complications of an stage renal disease?H
ypertension, heart failure, or REMIC cardiomyopathy, pulmonary Adema, cardiac Tampa nod, pericarditis
Types of heart failure and end-stage renal disease?
Uremic cardiomyopathy, AV fistula related high output cardiac failure
Prognosis for your remit cardiomyopathy?
Not that great honestly dialysis really improves left and circular function in patients with congestive heart failure
Why is pulmonary Dema and end-stage renal disease tricky?
Because it can be very calm and due to fluid overload, but you cannot rule out acute myocardial ischemia
What is the ultimate treatment forPulmonary edema and renal patients?
Hemodialysis. Not peritoneal dialysis it does not remove volume fast enough to have a significant impact
End stage renal disease patient with changes in mental status, hypertension, shortness of breath and intradialytic hypotension. Diagnosis?
Cardiac tamponade. Only do cardio centesis and unstable patients
What is a unique EKG feature of uremic pericarditis?
Because inflammatory cells do not penetrate into the myocardium, the typical changes of acute pericarditis or absent
Management of uremic pericarditis and how it’s different from normal pericarditis?
It’s manage with intensive dialysis. Systemic anticoagulation to be withheld if effusion is worsening. NSAIDS, culture scene, indomethacin Not useful in this type of pericarditis
What is it bleeding risk an ESRD patients?
They have an increased risk of G.I. tract bleeding subdural hematoma’s, liver hematoma’s and intraocular bleeding.
Treatment for coagulopathy a VSRD patients?
Desmopressin infusions, Cyroprecipitate, conjugated estrogens, tranexamic acid
Why are esrd patients Immunocompromise?
They have depressed leukocyte chemo taxis in phagocytosis along with abnormal tcell activation
What is the dangerous part of secondary hyperparathyroidism and renal disease patients?
Metastatic calcification. In addition to joint pain and Sudo gout, they can get skin and figure necrosis and life-threatening calcifications in the cardiac and pulmonary systems.
Treatment of metastatic calcification in renal patients
Low calcium Daisylate and phosphate binding gels
Other than metastatic calcification with another G.I. bone and joint condition that is unique to renal patients?
Beta to microglobulin amyloidosis. Can lead to G.I. perforation bone cyst and fractures
Why is heparin used for hemodialysis
To prevent thrombosis of the vascular access site
What is second line and third line vascular access for hemodialysis and why are they not as good?
First one is a native AV fistula. Second line is a bovine carotid artery graft but it is generally associated with a higher complication rate and shorter functional life expectancy. Third line is a tunneled catheter catheter in the right internal jugular vein. Don’t pull these out, and avoid central lines at that location in the SRD patients
Reasons for inadequate flow of vascular access site in dialysis patients?
Thrombosis or stenosis of the access site. They do clap removal or angioplasty or direct injection of alteplase with vascular surgery
What are the complications of vascular access sites for hemodialysis?
Infections, in adequate flow, bleeding, fistula, aneurysms, steel syndrome, high output heart failure
Infections A vascular access in hemodialysis patients. Management? How to treat?
Most people prefer a trial of IV antibiotics to maintain access. If there’s ongoing fear for 2 to 3 days it is removed. Treated with IV vancomycin and an aminoglycoside.
Why is vancomycin good And vascular access hemodialysis patients?
For one they get infected with Mrsa a lot. Second has a long half life so it is less affected by their compromised renal function.
What is the steel syndrome in hemodialysis
Preferential shunting of arterial blood to the Venus side access leaving to vascular insufficiency of the extremity distal to the access point leads to exercise pain nonhealing ulcer’s and cool pulseless digits
What is Branham sign?
A fallen heart rate after temporary access occlusion indicating high output heart failure related to hemodialysis
Definition of high output heart failure and hemodialysis
When greater than 20% of the credit app is diverted to the access surgical banding is the treatment of choice
Most frequent complication of dialysis
Hypertension occurs during 50% of treatments
Other than run-of-the-mill hypertension during dialysis, what else do you have to consider?
Myocardial dysfunction from ischemia, hypoxia, arrhythmias an early pericardial Tampa nod
What does it mean when there’s hypertension early in the dialysis session?
Probably pre-existing hypovolemia
What does hypertension near the end of dialysis usually mean?
Probably the result of excessive ultrafiltration. But pericardial or cardiac disease as possible.
What do you assess in the ED when a patient comes from hemodialysis center with hypertension?
Adequacy of volume status, impairment of cardiac function, pericardial disease and G.I. bleeding and infection
What does dialysis disequilibrium syndrome
It’s characterized by nausea vomiting hypertension which can progress the seizure, and death usually turn the first dialysis session to drink hyper catabolic states
Treatment for dialysis disequilibrium syndrome.
Stop the dialysis and administer 5 mL of 10 to 23% sodium chloride or mannitol to increase your osmolality.
Pathophysiology of dialysis disequilibrium syndrome
Probably related to cerebral edema from an Osmo and balance between the brain and the blood the blood has a transient lower osmolality than a brain which favors water move into the brain
What are the three main complications during hemodialysis?
Hypertension dialysis disequilibrium air embolus, electrolyte disturbances
Treatment for air embolism And hemodialysis?
Clamp the venous blood line and place the patient supine. Give 100% oxygen to aid in reabsorption. Maybe contact HR for aspiration from the right ventricle
Main electrolyte abnormalities in dialysis?
Hypoglycemia and hyperkalemia
Dialysis patient comes in with neurologic symptoms and systemic hypertension. What is a major concern
Air embolus
What are the two major complications of peritoneal dialysis?
Peritonitis, PD access site infections, and hernias
How to diagnose peritoneal dialysis related peritonitis?
Have to do a diagnostic paracentesis which would show a cell count greater than 100 leukocytes with greater than 50% neutrophils. Gram stain is unreliable.
Treatment for peritonitis from peritoneal dialysis?
A few rapid exchanges of fluid lavage, include heparin to decrease febrile clot formation, and use a first generation cephalosporin.
