Chronic Kidney Disease Flashcards
What does chronic kidney disease invovle
Involves progressive, irreversible loss of kidney function lasting longer than 3 months. Irreversible loss of kidney function
Disease staging based on decrease in GFR
Normal GFR: 125 mL/min, which is reflected by urine creatinine clearance. When less than 60ml for over 3 months
Last stage of kidney failure
End-stage kidney disease (ESKD/ESRD) occurs when GFR <15 mL/min
Leading causes of ESRD
Diabetes- Biggest cause. Educate regarding importance of medication compliance
Hypertension
Result of retained substances
Urea
Creatinine
Phenols
Electrolytes
Water
Clinical Manifestations Urinary System
Polyuria- goes along with DM
Oliguria
Occurs as CKD worsens
Anuria
Urine output lower than 40 mL per 24 hours
Clinical Manifestations Metabolic Disturbances
Waste product accumulation
As GFR ↓, BUN and serum creatinine levels ↑
BUN level ↑
Defective carbohydrate metabolism
Patients with diabetes who develop uremia may require less insulin after onset of CKD- Different sliding scale due to the insulin not clearing the system and staying in the system longer
Excretion of insulin dependent on kidneys
Elevated triglyceride levels- Due to hyperinsulin it stimulate the liver to produce more triglycerides
Hyperkalemia
Sodium
Clinical Manifestations Electrolyte/Acid-Base Imbalances
Calcium and phosphate alterations
Magnesium alterations- Try not to give laxatives that have meagnesium in them
Metabolic acidosis- Because the kidneys are not able to excrete excessive acid and defective ability to absorb bicarbonate
Clinical Manifestations Hematologic system
Anemia
Due to ↓ production of erythropoietin- Triggers production of blood
Bleeding tendencies
Defect in platelet function- Because we will have decreased coagulation proteins. Impaired release of platelet factor 3
Clinical Manifestations Cardiovascular system
Hypertension
Heart failure
Left ventricular hypertrophy
Peripheral edema
Dysrhythmias
Uremic pericarditis
Clinical Manifestations Respiratory system
Kussmaul respirations-Body trying to remove carbon dioxide through exhalation.
Dyspnea may occur
Clinical Manifestations Gastrointestinal system
Every part of GI system is affected
Cause: excessive urea
Mucosal ulcerations
Stomatitis
Uremic fetor (urinous odor of breath)
GI bleeding- Due to decreased clotting factor
Anorexia, nausea, vomiting
Constipation-Due to limited fluid intake and decreased mobility
Clinical Manifestations Neurologic system
Restless legs syndrome
Muscle twitching- Due to electrolyte changes
Irritability
Decreased ability to concentrate
Peripheral neuropathy- Can be related to the restless leg syndrome too
Altered mental ability
Seizures
Coma
Dialysis encephalopathy
Clinical manifestations Musculoskeletal system
CKD mineral and bone disorder- Issues absorbing minerals
Systemic disorder of mineral and bone metabolism
Results in
Skeletal complications (osteomalacia-bones become soft, ostetis fibrosa-Bones are deformed and very soft)
Extraskeletal (vascular calcifications)- Due to not absorbing minerals
Clinical manifestations Integumentary system
Pruritus- Salts that are not being excreted properly
Uremic frost- White patches. Crystalized Urea
Clinical manifestations Reproductive system
Infertility
Experienced by both sexes
Decreased libido
Low sperm counts
Sexual dysfunction
Clinical manifestations Psychologic changes
Personality and behavioral changes
Emotional lability- Rapid, exaggerated mood changes
Withdrawal
Depression
Diagnostic Studies
History and physical examination
Dipstick evaluation
Albumin-to-creatinine ratio (first morning void)88-128 mL/min in men 97-137 for women
GFR-normal=90-120 mL/min
Renal ultrasonography
Renal scan
CT scan
Renal biopsy
Overall goals
Preserve existing kidney function
Reduce the risks of CV disease
Prevent complications
Provide for the patient’s comfort
Conservative therapy
Correction of extracellular fluid volume overload or deficit
Nutritional therapy
Erythropoietin therapy
Calcium supplementation, phosphate binders
Antihypertensive therapy
Measures to lower potassium
Adjustment of drug dosages to degree of renal function
Drug therapy
Hyperkalemia
IV insulin
IV glucose to manage hypoglycemia
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate
Drug therapy
Hypertension
Hypertension
Weight loss
Lifestyle changes
Diet recommendations
Sodium and fluid restriction
Antihypertensive drugs
Diuretics.. Daily weights and Potassium levels
Calcium channel blockers
ACE inhibitors..Potassium retention- the Prils - Make you retain K+
ARB agents- Angiotensin 2 receptor blockers
Drug therapy
CKD-MBD
Phosphate not restricted until patient requires renal replacement therapy
Phosphate intake restricted to less than 1000 mg/day
Phosphate binders- Give with meals
Phosphate binders
Calcium acetate (PhosLo)
Calcium carbonate (Caltrate)
Bind phosphate in bowel and in excretement
Sevelamer hydrochloride (Renagel)
Lowers cholesterol and LDL levels
Drug therapy
Anemia
Erythropoietin
Iron supplements
Folic acid supplements
Avoid blood transfusions- Do not want to overload them with Iron- Also body produces antibodies-can increase risk of rejection if the need for kidney transplant is there
Drug therapy
Dyslipidemia
Statins
HMG-CoA reductase inhibitors
Most effective for lowering LDL level
Drug therapy
Complications
Drug toxicity
Digoxin
Antibiotics
Pain medication (meperidine [Demerol], NSAIDs)
Nutritional therapy
Protein restriction- not in dialysis
Water restriction
Sodium restriction
Potassium restriction
Limit: 2 to 3 gPhosphate restriction
Limit: 1000 mg/day
Foods high in phosphate
Dairy products-avoid
Most foods high in phosphate are also high in protein
High-potassium foods should be avoided- What kind of foods
