Chronic Kidney Disease Flashcards
1
Q
GFR Staging
A
Stage 1 - >/= 90 Stage 2 - 60-89 Stage 3a - 45-59 Stage 3b - 44-30 Stage 4 - 29-15 Stage 5 < 15
2
Q
Complications of CKD Stage 3-5
A
- Hypertension: look for volume control, adherence to meds, patient education about meds, lifestyle modifications
- Anemia
- Malnutrition: assess weight, prealbumin/albumin, and dietary hx, get dietary involved, supplements, weight monitoring
- Bone Disease: assess serum PTH, calcium and phosphate levels, control phosphorus, phosphorus binders, vitamin D levels, DXA scans
- Neuro: assess paresthesias, mental status abnormalities, sleep disturbances, restless legs, neuropathy, mental exam, check electrolytes, sleep study, EEG
- Reduced functioning and well-being: assess for depression and anxiety, standardized self-assessment instruments such as Dartmouth DOOP chart, DUKE/DUSOI, SF-36
3
Q
Dietary Restrictions for CKD
A
- salt, protein, phosphorus, and potassium restriction
4
Q
Meds to hold in CKD
A
- Metformin, NSAIDs, acetaminophen, statins, diuretics, some antibiotics
5
Q
Why do we give lisinopril in CKD?
A
- give for HTN to reduce hyper-filtration injury and slow progression of CKD but can cause increased creatinine and K, and decrease in GFR
6
Q
When do we stop lisinopril (or ACEs)?
A
- if creatinine rises > 30% or GFR falls < 25%
- if creatining rises < 30% and GFR falls < 25%
- if K > 6
7
Q
Intermittent HD
A
- most freqently used RRT
- tx usually takes 3-4 hours
- solute removal is diffusive
- advantage - rapid removal, quick correction of electrolytes
- disadvantage - hypotension (most common), n/v, headache
- Dialysis Disequilibrium - headaches, nausea, confusion, blurry vision (most common in patients just beginning dialysis, prevention is shorter HD run)
8
Q
CRRT
A
- preferred in critically ill AKI patients with severe hemodynamic instability
- slower, no large fluid or electrolyte shifts
- expensive, 1:1 nursing, special equipment
