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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
In addition to hypotension, ___ suggests effusion and potential tamponade
an increased heart size on chest radiograph
26
T or F: Bedside pericardiocentesis is used only in hemodynamically unstable patients because of its high complication rate
True
27
Uremic pericarditis is linked to
fluid overload, abnormal platelet function, and increased fibrinolysis and inflammation
28
BUN level in pericarditis related ESRD
>60 milligrams/dL
29
Dialysis-related pericarditis is most common during ___
periods of increased catabolism (trauma and sepsis) or inadequate dialysis due to missed sessions or vascular access problems
30
The pathophysiology of dialysis-related pericarditis is the buildup of ___
middle molecules and hyperparathyroidism
31
the most important complication of pericarditis in ESRD and tends to be recurrent
Pericardial effusion
32
If pericardial effusion persists for longer than 10 to 14 days with intensive dialysis. what can you offer as management?
anterior pericardiectomy
33
total pericardiectomy is reserved in condition called?
constrictive pericarditis
34
hematologic complication in ESRD seen in bone marrow
Bone marrow shows erythroid hypoplasia, with little effect on leukopoiesis or megakaryocytopoiesis
35
in ESRD, The ___ test is the best predictor of clinically important defects in hemostasis
skin bleeding
36
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)
True
37
key feature immune disorder in patient with ESRD
Depressed leukocyte chemotaxis and phagocytosis along with abnormal T-cell activation
38
what level of calcium-phosphate product will manifest metastatic calcification>
>70 - 80
39
Dialysis-related amyloidosis (β -microglobulin amyloidosis) can occur in dialysis patients ___
>50 years of age and on dialysis for >10 years
40
amyloid deposits are found in
GI tract, bones and joints
41
How many units of IV heparin are used to prevent thrombosis in hemodialysis?
1000 to 2000 units
42
Adjustment of this controls the amount of fluid removal (ultrafiltration) in hemodialysis
Pressure gradient across the hemodialyzer
43
Adjustment of this controls the amount of fluid removal (ultrafiltration) in hemodialysis
Pressure gradient across the hemodialyzer
44
Solute removal (clearance) during hemodialysis depends on what factors
Filter pore size Amount of ultrafiltration (solute drag) Concentration gradient across the filter (diffusion)
45
Normal ml/min circulated through dialysis machine
300 to 500 ml/min
46
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
True
47
Forms of vascular access for hemodialysis?
Arteriovenous fistula Interposing vascular graft Tunneled-cuff catheter
48
The most common site for tunneled-cuffed catheter placement?
Right internal jugular vein
49
Most common complications of hemodialysis vascular accees?
Failure to provide adequate flow (300ml//min) and infection
50
Most common cause of inadequate dialysis flow in hemodialysis patient
Thrombosis and stenosis
51
How stenosis and thrombosis of vascular site in HD patient treated?
Treated within 24 hours by angiographic clot removal or angioplasty Thrombosis - alteplase
52
How long does the patient with vascular access for HD develop bacteremia?
6 months
53
How can you say the patienthas cathter induced bacteremia in HD patient with vascular access?
Fourfold higher colony count in the catheter blood culture thean in the peripheral blood culture
54
Most common infecting organism in vascular access in HD patient?
S. Aureus
55
DOC for infected vascular access?
Vancomycin 15mg/kg or 1g IV Aminoglycosides (gentamicin 100mg IV initially and after each dialysis treatment) for gram neg organisms
56
If the patient with HD had bleeding complication and unknwon heparin dose given. What to give?
Protamine - 0.01mg/unit heparin If unknown heparin dose 10-20mg
57
If all measures fail in management of bleeding in vascular access with HD. What to give?
Tranexamic acid 10mg/kg IV
58
Vascular access aneurysm in HD patient are usually ____
Asymptomatic
59
What is the cause of vascular access pseudoaneurysms?
Subcutaneous extravasation of blood from puncture site
60
Preferential shunting of arterial blood to the venous side of the access
Steal syndrome
61
Best diagnostic approach for vascular insufficiency?
Dopples US or angiography
62
A sign that fall the heart rate after temporary access occlusion?
Branham sign
63
Treatment of choice to decrease flow and treat heart failure in patient with vascular access for HD
Surgical banding of the access
64
Most frequent complication of hemodialysis?
Hypotension
65
Most common cause of intradialytic hypotension
Wrong estimation of the patient's ideal volume (dry weight)
66
Hypotension early in the dialysis session usually due to
Preexisting hypovolemia
67
Hypotension near end of the dialysis usually result to
Excessive ultrafiltration or less common are pericaridal or cardiac disease
68
Hypotension near end of the dialysis usually result to
Excessive ultrafiltration or less common are pericaridal or cardiac disease
69
Management for intradialytic hypotension
Stop dialysis and trendelenburg position. If still hypotensive may give salt by mouth (broth) or 100 - 500 mL PNSS
70
Patient presented with nausea, vomiting and hypertension post HD
Dialysis disequilibrium
71
Treatment for dialysis disequilibrium
Stop HD and administer 10ml of 10% to 23% sodium chloride or mannitol 0.25mg/kg IV
72
Mechanism of dialysis disequilibrium
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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