chronic kidney disease and kidney failure (W3) Flashcards
azotemia
symptoms of build-up of toxins because of decreased of kidney function
oliguria
decrease of urine output, < 400 ml/24 hours
proteinuria
protein in urine because of damage to gomerulus
GFR
amount of blood filtered by glomerulus
function of kidneys
maintain fluid and electrolyte homeostasis, rid body of water-soluble waste via urine
3 important endocrine functions of the kidney
- produce erythropoietin which stimulates RBC production
- activates vitamin D- think bones
- produces renin, which helps regulate BP
lab values
BUN 10-20 mg/dL
creatinine 0.5-1.2 mg/dL
BUN and creatinine should have 10:1 ratio
GFR < 90 mL/min
what is CKD?
presences of kidney damage for more than 3 months with or without GFR of <60
inability to: maintain acid-base balance, removed end products of metabolism, maintain fluid and electrolyte balance
stages of CKD
1- kidney damage with normal or increased GFR (GFR > 90)
2. kidney damage with mild decreases in GFR (GFR 60-89)
3. moderate decrease in GFR (GFR 30-59)
4. severe decrease in GFR (12-29)
5. ESRD (GFR <15)
causes of ESRD
diabetes
hypertension
glomerulonephritis
other
RF for CKD
family history of CKD, vascular problems, diabetes
> 60 yo
men
african american
smoking
obese
htn
dm
pathogenesis of CKD
- glomerulosclerosis AKA scar tissue
- interstitial fibrosis
- interstitial inflammation
what plays a major role in the process?
complement, inflammatory process which results in destruction
increase of angiotensin 2, increase BP
manifestations of CKD
1- asymptomatic
2- asymptomatic/htn
3. htn/otherwise asymptomatic
4. manifestations aparent, diagnosis here!
5. uremia, kidneys no longer functioning, GFR <15
uremia
retention of metabolic waste, not voiding
back up of: urea, creatinine, phenols, hormones, electrolytes, water
SEEN WITH GFR < 10 mL/min
clinical manifestations of ESRD
effects basically every system
ESRD and clinical manifestations
kidney no longer maintains F/E homeostasis
no longer rids the body of wastes via urine
decreased production of erythropoietin
decreased vitamin D
kidney no longer maintains F/E homeostasis
causes edema, hyperphos/mag/k, metabolic acidosis
no longer rids the body of wastes via urine
anorexia, malnutrition, itching, CNS changes
decreased production of erythopoietin
anemia
decreased vitamin D
renal osteodystrophy, weakening of the bones
uremic frost
itchy/white
caused by high concentration of metabolic waste
pharm can be used to…
slow the rate of progression of CKD
1. reduce BP less than 140/90
2. treat hyperlipidemia, goal to have cholesterol < 200
treat complications
1. volume OL
2. hyperkalemia
3. metabolic acidosis
4. hyperphosphatemia
5. renal osteodystrophy
6. anemia
treating metabolic acidosis
sodium bicarb
po
goal to slow progression, prevent bone loss, improve nutritional status
administer when bicard is < 15 mEq/mL
AE: bloating- switch to sodium citrate
treating hyperphosphatemia
calcium carbonate
MOA: binds to phosphate
goal: keep levels normal and decrease mortality
education: take with meals
AE: hypercalcemia (monitor)
take as prescribed!
treating renal osteodystrophy
calcitriol
MOA: an active form of vitamin D, stimulates intestinal absorption of calcium/phosphate/bone mineralization
AE: hypercalcemia/hyperphosphatemia
signs of calcium toxicity: GI upset/bone pain/neuro effects/cardiac arrhythmias
complications of drug therapy
many drugs are excreted through the kidneys
renally dose
drugs of concern: diabetic agents, AB like vancomyocin, opiods like morphine, digoxin
