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renal > chronic kidney disease and dialysis > Flashcards

chronic kidney disease and dialysis Flashcards

1
Q

chronic kidney disease defined

A

abnormality of kidney structure of function that persists for > 3 months

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2
Q

main CKD diagnostic criteria

A

GFR <60cc/min or structural and functional abnormalities with a preserved GFR (>90 cc/min)

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3
Q

kidney failure/ESRD GFR

A

<15 ml/min/1.73m2 and on dialysis or some type of RRT

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4
Q

there is a normal decline in GFR with ____ due to ____

A

age

scarring

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5
Q

initial lab findings of CKD

A

decreased GFR

elevated Cr/BUN

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6
Q

Cr and BUN are _____ in CKD because…..

A

elevated

renal function is impaired so it is not being cleared and excreted

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7
Q

3 common causes of CKD

A

DM
HTN
GN

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8
Q

how can diabetes lead to CKD?

A

hyperglycemia leads to kidney cell damage and sclerosis/thickening of nephrons

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9
Q

how does HTN lead to CKD?

A

increased BP leads to sclerosis of afferent arterioles and decreases perfusion = ischemic damage

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10
Q

CKD complications

A 
(Kidney OUTAGES)
hyperKalemia
renal Osteodystrophy
Uremia
TGs
Acidosis (metabolic)
Growth delay
Erythropoietin deficiency
Sodium/water retention
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11
Q

reduced GFR leads to decreased____

A

excretion

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12
Q

clinical presentation of CKD

A

asymptomatic until later stages
presents as uremia (N/V, altered mentation, cramps, fluid overload)
fatigue, weakness, headaches

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13
Q

derm manifestations of CKD

A

pruritus due to uremia

pallor due to anemia

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14
Q

GI manifestations of CKD

A

N/V
anorexia
ammonia breath

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15
Q

neuro manifestations of CKD

A

asterixis
encephalopathy
peripheral neuropathy

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16
Q

why does CKD cause anemia

A

Erythropoietin deficiency (made by kidney) leads to decreased RBC production

it is worsened by uremia which causes RBC lysis

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17
Q

treatment of anemia due to CKD

A

replete iron and B12

exogenous EPO

18
Q

why does CKD cause metabolic acidosis?

A

decreased GFR means that kidney cannot excrete all the acid so it accumulates in the blood

19
Q

why does CKD cause renal osteodystrophy

A

failing kidneys cannot eliminate phosphate properly = hyperphosphatemia and they cannot convert vitamin D to its active form = decreased calcium absorption and PTH activation

20
Q

osteitis fibrosa cystica is due to ____ which causes____

A

overproduction of PTH in secondary hyperparathyroidism which causes bone breakdown by osteoclasts

21
Q

osteomalacia

A

aluminum in bone causes defective mineralization and increased matrix synthesis

complication of CKD

22
Q

CKD causes bone disorders due to two electrolyte imbalances (describe them) that both lead to increased ____

A

hyperphosphatemia
kidneys unable to make active vitamin D= low Ca

increased PTH

23
Q

adynamic bone disease

A

low bone turnover related to over suppressed PTH (no osteomalacia)

24
Q

renal osteodystrophy treatment

A

active vitamin D or calcium

25
Q

hyperphosphatemia in CKD pts can lead to

A

deposition of calcium phosphate in blood vessels = calcific arteries

26
Q

Hyperphosphatemia treatment

A

low phosphorus diet

phosphate binders to increase excretion

27
Q

why does hyperkalemia occur in CKD and why is it dangerous

A

kidneys excrete K

potassium can cause arrhythmias

28
Q

indications for dialysis

A 
Acidosis
Electrolyte abnormalities
Ingestion of toxins
Overload
Uremic symptoms
29
Q

goal of dialysis

A

to remove nitrogenous waste and replenish bicarbonate

30
Q

broad waxy casts are seen in

A

ESRD

31
Q

hemodialysis average time and frequency

A

4 hours 3x a week

32
Q

dialysis with lower risk of infection and enhanced quality of life

A

peritoneal dialysis

33
Q

peritoneal dialysis

A

solutes are exchanged between peritoneal blood supply and dialysis solution

34
Q

osmotic agent in dialysis

A

dextrose

35
Q

peritonitis organisms are most likely gram ____

A

positive (staph)

36
Q

indication for transplant

A

when GFR is <15

37
Q

chest pain with inhalation, friction rub on auscultation, CKD complication

A

uremic pericarditis

38
Q

_____ is the leading cause of death in patients undergoing dialysis

A

CVD

39
Q

best predictive test for CKD progression

A

urinary albumin/Cr to measure proteinuria

40
Q

what would a CKD pts PT/PTT and platelet count look like?

A

TRICK question
they would all be normal because the increased risk of bleeding because of uremia is due to platelet aggregation dysfunction (bruises

renal (17 decks)

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