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Section 10: Renal and Genitourinary Disorders > Chapter 90: End-Stage Renal Disease > Flashcards

Chapter 90: End-Stage Renal Disease Flashcards

1
Q

renal replacement therapy consists of two basic modalities

A

renal transplant
dialytic therapy (either hemodialysis or peritoneal dialysis

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2
Q

Besides urea, other potential uremic toxins include ___

A

cyanate, guanidine, polyamines, and β2-microglobulin

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3
Q

end-stage renal failure pathophysiology

A

excretory
biosynthetic
regulatory

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4
Q

refers to the aspects of uremia caused by loss of the renal hormones 1,25(OH)2-vitamin D3 and erythropoietin

A

biosynthetic failure

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5
Q

Vitamin D3 deficiency results in ___

A

decreased GI calcium absorption, inducing secondary hyperparathyroidism and leading to renal bone disease.

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6
Q

results in an oversecretion of hormones, leading to uremia by disruption of normal feedback mechanisms

A

regulatory failure

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7
Q

excess free radicals will react to ___ that create what?

A

react with carbohydrates, lipids, and amino acids to create advanced glycation end products, linked to atherosclerosis and amyloidosis in ESRD patients

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8
Q

The most common reasons for emergency dialysis are ___

A

fluid overload (51%), hyperkalemia (18%), and severe acid-base disturbances

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9
Q

the most common indication for non emergent dialysis

A

uremia

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10
Q

Stroke occurs in approximately ___ of hemodialysis patients

A

6%

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11
Q

Subdural hematomas occur ___ more frequently in dialysis patients than in the general population

A

10 times more

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12
Q

constellation of nonspecific central neurologic symptoms associated with renal failure

A

uremic encephalopathy

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13
Q

how uremic encephalopathy diagnosed?

A

eliminating structural, vascular, infectious, toxic, and metabolic causes of neurologic dysfunction

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14
Q

in MRI with uremic encephalopathy shows

A

basal ganglia lesions

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15
Q

dialysis dementia will become evident after at least

A

2 years of dialysis therapy

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16
Q

is one of the most frequent neurologic manifestations of ESRD

A

peripheral neuropathy

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17
Q

T or F:
peripheral neuropathy associated ESRD will manifest greater lower than upper limb?

A

true

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18
Q

common cardiovascular complication of ESRD

A

Coronary artery disease
left ventricular hypertrophy congestive heart failure

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19
Q

hypertension management with ESRD if control of volume is unsuccessful?

A

adrenergic blocking agents angiotensin-converting enzyme inhibitors
vasodilating agents

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20
Q

___ is the most common cause of heart failure in ESRD

A

hypertension

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21
Q

heart failure causes unique to ESRD are

A

uremic cardiomyopathy
fluid overload
arteriovenous fistula–related high-output failure

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22
Q

___ levels are elevated in hemodialysis patients, often from concomitant left ventricular hypertrophy and systolic dysfunction

A

Natriuretic peptide

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23
Q

cornerstone treatment for pulmonary edema in ESRD

A

supplemental oxygen if needed
bilevel positive airway pressure
nitrates
angiotensin-converting enzyme inhibitors

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24
Q

Removing as little as ___ of blood is safe and effective in some with pulmonary edema

A

150 mL

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25
Q

In addition to hypotension, ___ suggests effusion and potential tamponade

A

an increased heart size on chest radiograph

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26
Q

T or F:
Bedside pericardiocentesis is used only in hemodynamically unstable patients because of its high complication rate

A

True

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27
Q

Uremic pericarditis is linked to

A

fluid overload, abnormal platelet function, and increased fibrinolysis and inflammation

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28
Q

BUN level in pericarditis related ESRD

A

> 60 milligrams/dL

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29
Q

Dialysis-related pericarditis is most common during ___

A

periods of increased catabolism (trauma and sepsis) or inadequate dialysis due to missed sessions or vascular access problems

30
Q

The pathophysiology of dialysis-related pericarditis is the buildup of ___

A

middle molecules and hyperparathyroidism

31
Q

the most important complication of pericarditis in ESRD and tends to be recurrent

A

Pericardial effusion

32
Q

If pericardial effusion persists for longer than 10 to 14 days with intensive dialysis. what can you offer as management?

A

anterior pericardiectomy

33
Q

total pericardiectomy is reserved in condition called?

A

constrictive pericarditis

34
Q

hematologic complication in ESRD seen in bone marrow

A

Bone marrow shows erythroid hypoplasia, with little effect on leukopoiesis or megakaryocytopoiesis

35
Q

in ESRD, The ___ test is the best predictor of clinically important defects in hemostasis

A

skin bleeding

36
Q

T orF:
Improvement in bleeding times is seen with infusions of desmopressin, 0.3 microgram/kg IV/SC (benefit in 1 hour), or cryoprecipitate, 10 units given over 30 minutes (benefit in 4 hours). Conjugated estrogens, 25 milligrams IV or 6 milligrams/kg/d (benefit in 6 hours)

A

True

37
Q

key feature immune disorder in patient with ESRD

A

Depressed leukocyte chemotaxis and phagocytosis along with abnormal T-cell activation

38
Q

what level of calcium-phosphate product will manifest metastatic calcification>

A

> 70 - 80

39
Q

Dialysis-related amyloidosis (β -microglobulin amyloidosis) can occur in dialysis patients ___

A

> 50 years of age and on dialysis for >10 years

40
Q

amyloid deposits are found in

A

GI tract, bones and joints

41
Q

How many units of IV heparin are used to prevent thrombosis in hemodialysis?

A

1000 to 2000 units

42
Q

Adjustment of this controls the amount of fluid removal (ultrafiltration) in hemodialysis

A

Pressure gradient across the hemodialyzer

43
Q

Adjustment of this controls the amount of fluid removal (ultrafiltration) in hemodialysis

A

Pressure gradient across the hemodialyzer

44
Q

Solute removal (clearance) during hemodialysis depends on what factors

A

Filter pore size
Amount of ultrafiltration (solute drag)
Concentration gradient across the filter (diffusion)

45
Q

Normal ml/min circulated through dialysis machine

A

300 to 500 ml/min

46
Q

T or F:
Dialysate usually flows at a rate of 500 to 800ml/min through the dialysis filter in the direction oposite to blood flow

A

True

47
Q

Forms of vascular access for hemodialysis?

A

Arteriovenous fistula
Interposing vascular graft
Tunneled-cuff catheter

48
Q

The most common site for tunneled-cuffed catheter placement?

A

Right internal jugular vein

49
Q

Most common complications of hemodialysis vascular accees?

A

Failure to provide adequate flow (300ml//min) and infection

50
Q

Most common cause of inadequate dialysis flow in hemodialysis patient

A

Thrombosis and stenosis

51
Q

How stenosis and thrombosis of vascular site in HD patient treated?

A

Treated within 24 hours by angiographic clot removal or angioplasty

Thrombosis - alteplase

52
Q

How long does the patient with vascular access for HD develop bacteremia?

A

6 months

53
Q

How can you say the patienthas cathter induced bacteremia in HD patient with vascular access?

A

Fourfold higher colony count in the catheter blood culture thean in the peripheral blood culture

54
Q

Most common infecting organism in vascular access in HD patient?

A

S. Aureus

55
Q

DOC for infected vascular access?

A

Vancomycin 15mg/kg or 1g IV
Aminoglycosides (gentamicin 100mg IV initially and after each dialysis treatment) for gram neg organisms

56
Q

If the patient with HD had bleeding complication and unknwon heparin dose given. What to give?

A

Protamine - 0.01mg/unit heparin
If unknown heparin dose 10-20mg

57
Q

If all measures fail in management of bleeding in vascular access with HD. What to give?

A

Tranexamic acid 10mg/kg IV

58
Q

Vascular access aneurysm in HD patient are usually ____

A

Asymptomatic

59
Q

What is the cause of vascular access pseudoaneurysms?

A

Subcutaneous extravasation of blood from puncture site

60
Q

Preferential shunting of arterial blood to the venous side of the access

A

Steal syndrome

61
Q

Best diagnostic approach for vascular insufficiency?

A

Dopples US or angiography

62
Q

A sign that fall the heart rate after temporary access occlusion?

A

Branham sign

63
Q

Treatment of choice to decrease flow and treat heart failure in patient with vascular access for HD

A

Surgical banding of the access

64
Q

Most frequent complication of hemodialysis?

A

Hypotension

65
Q

Most common cause of intradialytic hypotension

A

Wrong estimation of the patient’s ideal volume (dry weight)

66
Q

Hypotension early in the dialysis session usually due to

A

Preexisting hypovolemia

67
Q

Hypotension near end of the dialysis usually result to

A

Excessive ultrafiltration or less common are pericaridal or cardiac disease

68
Q

Hypotension near end of the dialysis usually result to

A

Excessive ultrafiltration or less common are pericaridal or cardiac disease

69
Q

Management for intradialytic hypotension

A

Stop dialysis and trendelenburg position. If still hypotensive may give salt by mouth (broth) or 100 - 500 mL PNSS

70
Q

Patient presented with nausea, vomiting and hypertension post HD

A

Dialysis disequilibrium

71
Q

Treatment for dialysis disequilibrium

A

Stop HD and administer 10ml of 10% to 23% sodium chloride or mannitol 0.25mg/kg IV

72
Q

Mechanism of dialysis disequilibrium

A

Cerebral edema
Blood transiently lower osmolality than the brain due to high solute removal during dialysis

Section 10: Renal and Genitourinary Disorders (8 decks)

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