Chronic Kidney Disease Flashcards
What is the difference between chronic kidney disease and acute kidney disease?
Acute kidney disease happens very fast and normally if you treat the underlying problem it goes back to normal.
Whereas chronic kidney disease happens over someone’s lifetime
What is End Stage Renal Disease and what laboratory values indicate it?
The stage where kidneys cannot sustain life
This is indicated by a SCr of 10 and a BUn of 100
What are the two national guidelines for kidney disease?
KDOQI + KDIGO
How often/how long does dialysis happen?
Dialysis happens 3 days a week for 4 hours
What are the major causes of CKD?
-Diabetes mellitus
-Hypertension
-Glomerulonephritis
-Polycystic Kidney Disease (PKD) *common in young people
-Nephropathy
How is CKD defined by KDIGO?
Abnormalities of kidney structure, present for >3months with implications for health
How is CKD classified?
Based on cause, GFR, and albuminuria category
What is uremia?
A cluster of symptoms associated with End Stage renal Disease. Symptoms are typically due to accumulation of waste molecules in the blood that are normally removed by the kidneys
Which lab value is monitored for signs of uremia?
BUN (blood urea nitrogen)
What are the functions of the kidney?
- Excrete waste products of metabolism from the blood
- Regulates the body’s concentration of water and salt
- Maintains acid balance of plasma
- Synthesizes calcitriol
- Secretes hormones
Will diuretics work in patients with kidney disease?
Will not work in patients with no functioning kidney!!!!
-Can be used in stage 3 and 4
What considerations should be addressed when using diuretics with kidney disease?
- Thiazides are ineffective when CrCl< 30ml/min
- Loops will work when CrCl<30ml/min
- Furosemide bioavailability is about 50% (oral dose may be twice the IV dose)
- Avoid potassium-sparing diuretics!
- As renal function declines and loop diuretics reach max dose, thiazides may be added to overcome diuretic resistance
What is the one loop diuretic that is not a sulfa-type drug?
Ethacrynic acid
What should the daily sodium intake be for a patient with high sodium levels?
<2g sodium/ day
OR
<5g NaCl /day
What should the daily potassium intake be for a patient with high potassium levels?
3 gm/day
Which of the following diuretics is least likely to cause an allergic sulfa reaction?
A. furosemide
B. ethacrynic acid
C. torsemide
D. bumetanide
B. ethacrynic acid
What are the 3 things that affect the parathyroid gland and how do they affect it?
High phosphorus
Low calcium
Low Vitamin D
*All three of these increase PTH release
*Phosphorus has the greatest impact
When should dietary phosphorus intake be restricted to 800-1000 mg/day?
1) Phos >4.6 mg/dL (stage 3 and 4)
2) Phos > 5.5 mg/dL (stage 5)
3) PTH > Target range for stage 3, 4, or 5
What is the role of erythropoietin (EPO)?
Promotes production of mature red blood cells in the bone marrow
-Having more red blood cells in the circulation leads to increased oxygenation and lower levels of hypoxia-inducible factor which suppresses EPO production
*EPO is made by the kidneys
What are the monitoring parameters for anemia?
Hb (hemoglobin)
MCV (mean corpuscular volume)
RDW (red cell distribution width)
TSAT
Ferritin
What are the 4 mechanisms by which ESRD patients will develop anemia?
1) Decreased production of erythropoietin ***(main)
2) Uremia causes a decreased life span of red blood cells
3) Vitamin losses during dialysis
4) Dialysis (loss of blood through dialyzer (hemolysis))
What are the symptoms of anemia?
Headache
Palor
Decreased cognition
Fatigue
What is microcytic anemia?
Blood cells are small
(Low MCV)
What is macrocytic anemia?
Blood cells are large
(High MCV)
What is normocytic anemia?
The blood cells are a normal size, but there is less of them than normal
What is the best assessment parameter for anemia?
Hb is the best assessment parameter because it has increased stability over Hct (hematocrit)
What is the relationship between transferrin and ferritin?
Transferrin is the delivery truck and ferritin is the stored iron (warehouse)
