chronic kidney disease and ESKD

Question 1

what is chronic kidney disease

Answer 1

presence of kidney damage for more than 3 months with or without a GFR (glomerular filtration rate) of <60

Question 2

in chronic kidney disease there is an inability to

Answer 2

maintain acid-base balance, remove end products of metabolism, maintain fluid and electrolyte balance

Question 3

causes of CKD

Answer 3

hypertension, diabetes, glomerulonephritis

Question 4

risk factors of CKD

Answer 4

family history, increase age > 60, male, african american, HTN, DM, smoking, overweight/obesity

Question 5

patho of CKD

Answer 5

glomerulosclerosis (scar tissues of glomerus) –> cannot properly filter blood –> interstitial fibrosis –> interstitial inflammation

Question 6

what plays a role in CKD

Answer 6

complement (part of inflammatory process causes destruction of kidney tissues) angiotensin 2 –> increases BP –> more damage

Question 7

how to treat CKD

Answer 7

reduce BP, treat hyperlipidemia, volume overload, hypekalemia, metabolic acidosis, hyperphosphatemia, renal osteodystrophy, anemia

Question 8

stages of CKD

Answer 8

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

Question 9

treatment for hyperphosphatemia

Answer 9

calcium carbonate (Tums)
MOA: binds to phosphate
Goal: keep phosphate levels normal
take with meals

Question 10

treatment for metabolic acidosis

Answer 10

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

Question 11

treatment for renal osteodystrophy

Answer 11

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

Question 12

what is uremia

Answer 12

retention of metabolic waste building up due to lack of kidney filtration –> measured in BUN/Cr, electrolytes, retaining water –> GFR

Question 13

clinical manifestations of end stage kidney disease

Answer 13

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