chronic kidney disease and dialysis Flashcards
chronic kidney disease defined
abnormality of kidney structure of function that persists for > 3 months
main CKD diagnostic criteria
GFR <60cc/min or structural and functional abnormalities with a preserved GFR (>90 cc/min)
kidney failure/ESRD GFR
<15 ml/min/1.73m2 and on dialysis or some type of RRT
there is a normal decline in GFR with ____ due to ____
age
scarring
initial lab findings of CKD
decreased GFR
elevated Cr/BUN
Cr and BUN are _____ in CKD because…..
elevated
renal function is impaired so it is not being cleared and excreted
3 common causes of CKD
DM
HTN
GN
how can diabetes lead to CKD?
hyperglycemia leads to kidney cell damage and sclerosis/thickening of nephrons
how does HTN lead to CKD?
increased BP leads to sclerosis of afferent arterioles and decreases perfusion = ischemic damage
CKD complications
(Kidney OUTAGES) hyperKalemia renal Osteodystrophy Uremia TGs Acidosis (metabolic) Growth delay Erythropoietin deficiency Sodium/water retention
reduced GFR leads to decreased____
excretion
clinical presentation of CKD
asymptomatic until later stages
presents as uremia (N/V, altered mentation, cramps, fluid overload)
fatigue, weakness, headaches
derm manifestations of CKD
pruritus due to uremia
pallor due to anemia
GI manifestations of CKD
N/V
anorexia
ammonia breath
neuro manifestations of CKD
asterixis
encephalopathy
peripheral neuropathy
why does CKD cause anemia
Erythropoietin deficiency (made by kidney) leads to decreased RBC production
it is worsened by uremia which causes RBC lysis
treatment of anemia due to CKD
replete iron and B12
exogenous EPO
why does CKD cause metabolic acidosis?
decreased GFR means that kidney cannot excrete all the acid so it accumulates in the blood
why does CKD cause renal osteodystrophy
failing kidneys cannot eliminate phosphate properly = hyperphosphatemia and they cannot convert vitamin D to its active form = decreased calcium absorption and PTH activation
osteitis fibrosa cystica is due to ____ which causes____
overproduction of PTH in secondary hyperparathyroidism which causes bone breakdown by osteoclasts
osteomalacia
aluminum in bone causes defective mineralization and increased matrix synthesis
complication of CKD
CKD causes bone disorders due to two electrolyte imbalances (describe them) that both lead to increased ____
hyperphosphatemia
kidneys unable to make active vitamin D= low Ca
increased PTH
adynamic bone disease
low bone turnover related to over suppressed PTH (no osteomalacia)
renal osteodystrophy treatment
active vitamin D or calcium
hyperphosphatemia in CKD pts can lead to
deposition of calcium phosphate in blood vessels = calcific arteries
Hyperphosphatemia treatment
low phosphorus diet
phosphate binders to increase excretion
why does hyperkalemia occur in CKD and why is it dangerous
kidneys excrete K
potassium can cause arrhythmias
indications for dialysis
Acidosis Electrolyte abnormalities Ingestion of toxins Overload Uremic symptoms
goal of dialysis
to remove nitrogenous waste and replenish bicarbonate
broad waxy casts are seen in
ESRD
hemodialysis average time and frequency
4 hours 3x a week
dialysis with lower risk of infection and enhanced quality of life
peritoneal dialysis
peritoneal dialysis
solutes are exchanged between peritoneal blood supply and dialysis solution
osmotic agent in dialysis
dextrose
peritonitis organisms are most likely gram ____
positive (staph)
indication for transplant
when GFR is <15
chest pain with inhalation, friction rub on auscultation, CKD complication
uremic pericarditis
_____ is the leading cause of death in patients undergoing dialysis
CVD
best predictive test for CKD progression
urinary albumin/Cr to measure proteinuria
what would a CKD pts PT/PTT and platelet count look like?
TRICK question
they would all be normal because the increased risk of bleeding because of uremia is due to platelet aggregation dysfunction (bruises
