chronic kidney disease and ESKD Flashcards
what is chronic kidney disease
presence of kidney damage for more than 3 months with or without a GFR (glomerular filtration rate) of <60
in chronic kidney disease there is an inability to
maintain acid-base balance, remove end products of metabolism, maintain fluid and electrolyte balance
causes of CKD
hypertension, diabetes, glomerulonephritis
risk factors of CKD
family history, increase age > 60, male, african american, HTN, DM, smoking, overweight/obesity
patho of CKD
glomerulosclerosis (scar tissues of glomerus) –> cannot properly filter blood –> interstitial fibrosis –> interstitial inflammation
what plays a role in CKD
complement (part of inflammatory process causes destruction of kidney tissues) angiotensin 2 –> increases BP –> more damage
how to treat CKD
reduce BP, treat hyperlipidemia, volume overload, hypekalemia, metabolic acidosis, hyperphosphatemia, renal osteodystrophy, anemia
stages of CKD
1: kidney damage w/ normal or increased GFR >/= 90
2: kidney damage w/mild decrease in GFR 60-89
3: moderate decrease in GFR 30-59
4: severe decrease in GFR 15-29
5: end stage kidney disease GFR <15
treatment for hyperphosphatemia
calcium carbonate (Tums)
MOA: binds to phosphate
Goal: keep phosphate levels normal
take with meals
treatment for metabolic acidosis
sodium bicarbonate
for slow progression, to prevent bone loss, improve nutritional status
initiate when HCO3 is <15
titrate to HCO3 of 18-20 –> if there is bloating switch to sodium citrate
treatment for renal osteodystrophy
calcitriol
moa: activated form of Vit D, stimulates intestinal absorption of calcium/phosphate and bone mineralization
Adverse effects: hypercalcemia, hyperphosphatemia, s/s of calcium toxicity –> GI upset, bone pain, neuro effects, cardiac arrhythmia
what is uremia
retention of metabolic waste building up due to lack of kidney filtration –> measured in BUN/Cr, electrolytes, retaining water –> GFR
clinical manifestations of end stage kidney disease
no longer maintains fluid and electrolyte homeostasis –> edema, hyperkalemia, hyperphosphatemia, hypermag, metabolic acidosis
no longer rids body of waste –> anorexia, malnutrition, itching, CNS changes
decreased production of erythropoietin –> anemia and renal osteodystrophy