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Medical Surgical GI Exam 3 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What does chronic kidney disease invovle

A

Involves progressive, irreversible loss of kidney function lasting longer than 3 months. Irreversible loss of kidney function

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2
Q

Disease staging based on decrease in GFR

A

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

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3
Q

Leading causes of ESRD

A

Diabetes- Biggest cause. Educate regarding importance of medication compliance
Hypertension

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4
Q

Result of retained substances

A

Urea
Creatinine
Phenols
Electrolytes
Water

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5
Q

Clinical Manifestations Urinary System

A

Polyuria- goes along with DM
Oliguria
Occurs as CKD worsens
Anuria
Urine output lower than 40 mL per 24 hours

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6
Q

Clinical Manifestations Metabolic Disturbances

A

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

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7
Q

Clinical Manifestations Electrolyte/Acid-Base Imbalances

A

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

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8
Q

Clinical Manifestations Hematologic system

A

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

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9
Q

Clinical Manifestations Cardiovascular system

A

Hypertension
Heart failure
Left ventricular hypertrophy
Peripheral edema
Dysrhythmias
Uremic pericarditis

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10
Q

Clinical Manifestations Respiratory system

A

Kussmaul respirations-Body trying to remove carbon dioxide through exhalation.
Dyspnea may occur

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11
Q

Clinical Manifestations Gastrointestinal system

A

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

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12
Q

Clinical Manifestations Neurologic system

A

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

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13
Q

Clinical manifestations Musculoskeletal system

A

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

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14
Q

Clinical manifestations Integumentary system

A

Pruritus- Salts that are not being excreted properly
Uremic frost- White patches. Crystalized Urea

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15
Q

Clinical manifestations Reproductive system

A

Infertility
Experienced by both sexes
Decreased libido
Low sperm counts
Sexual dysfunction

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16
Q

Clinical manifestations Psychologic changes

A

Personality and behavioral changes
Emotional lability- Rapid, exaggerated mood changes
Withdrawal
Depression

17
Q

Diagnostic Studies

A

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

18
Q

Overall goals

A

Preserve existing kidney function
Reduce the risks of CV disease
Prevent complications
Provide for the patient’s comfort

19
Q

Conservative therapy

A

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

20
Q

Drug therapy
Hyperkalemia

A

IV insulin
IV glucose to manage hypoglycemia
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate

21
Q

Drug therapy
Hypertension

A

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

22
Q

Drug therapy
CKD-MBD

A

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

23
Q

Drug therapy
Anemia

A

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

24
Q

Drug therapy
Dyslipidemia

A

Statins
HMG-CoA reductase inhibitors
Most effective for lowering LDL level

25
Q

Drug therapy
Complications

A

Drug toxicity
Digoxin
Antibiotics
Pain medication (meperidine [Demerol], NSAIDs)

26
Q

Nutritional therapy

A

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

27
Q
A

Medical Surgical GI Exam 3 (21 decks)

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