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Complex Health I > Chronic Kidney Disease/End Stage Kidney Disease FINAL > Flashcards

Chronic Kidney Disease/End Stage Kidney Disease FINAL Flashcards

1
Q

GFR (kidney function) is used to stage

A

chronic kidney disease

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2
Q

eGFR considers creatinine levels, gender, race, and body size but it only used for screening & antibiotic/med dosing.

True or False

A

True

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3
Q

GFR > 90mL/min

At risk, normal kidney function but urine findings, structural abnormalities, or genetic trait points to kidney disease

A

Stage 1

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4
Q

GFR 60-89mL/min

Mild CKD; reduced kidney function; lab values and other findings point to kidney disease

Focus on reduction of risk factors

A

Stage 2

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5
Q

GFR 30-59mL/min

Moderate CKD

Implement strategies to slow disease progression

A

Stage 3

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6
Q

GFR 15-29mL/min

Severe CKD

Manage complications; Education on renal replacement therapy

A

Stage 4

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7
Q

GFR < 15mL/min

End stage kidney disease (ESKD)

Implement renal replacement therapy or kidney transplant

A

Stage 5

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8
Q

What is the leading cause of death in patients with ESKD?

A

CVD

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9
Q

Is CKD/ESKD reversible?

A

No. It is progressive, irreversible, w/no recovery.

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10
Q

S/Sx

A
  • Uremia
  • Azotemia
  • Anuria
  • Uremic fetor
  • Stomatitis
  • Halitosis
  • Metallic taste in mouth/anorexia/nausea
  • Polyuria
  • Pruritis
  • HTN
  • Hyperlipidemia
  • Anemia
  • Increased risk of infection
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11
Q

Erythropoietin injections for

A

anemia

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12
Q

Erythropoietin stim agents reminders

Epoetin alfa

A

Should not be given when hemoglobin is greater than 13g/dL and pt is hypertensive

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13
Q

Manifestations of ESKD

A

Neuro: HA, weakness & fatigue, sleep disturbances
Cardio: ^BP, Pitting edema, HF, PAD
Pulm: pulmonary edema, pneumonia
GI: ammonia odor breath, metallic taste, anorexia, NV, GI bleeding
Psych: withdrawn, depressed, behavioral changes
Hematologic: anemia, infection, bleeding tendencies
Fluid and electrolytes: ^Pot, metabolic acidosis
Skin: dry & flaky, pruritis, ecchymosis, yellow-grey color
Musculoskeletal: cramps, bone pain, renal osteodystrophy

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14
Q
  • Decrease calcium (Trousseau’s Sign, Chvostek’s Sign, Fractures)
  • Increased clotting time
  • Anxiety and irritability
  • Heart arrhythmias
  • Increased serum calcium and serum phosphorus
  • Vascular and soft tissue calcifications - > calcium is deposited in atherosclerotic plaques in the lining of blood vessels - > increased CVD
A

CKD-MBD (Mineral and Bone Disorder)/Renal Osteodystrophy

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15
Q

Risk factors for CKD

A

diabetes, hypertension, age>60, cardiovascular disease, family hx of CKD, exposure to nephrotoxic drugs, ethnic minority (African American, Native American)

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16
Q

Nephrotoxic drugs

A

antibiotics/antimicrobials, aminoglycoside antibiotics, chemotherapy agents, NSAIDs

Others- acetaminophen, metformin, pesticides, radiographic contrast medium, fungicides, arsenic, lead, copper sulfate, bismuth

17
Q

Labs

A

Increased serum creatinine
Increased BUN
Decreased Na (hyponatremia)
Increased K (hyperkalemia)

18
Q

Diagnostics

A

ABG - metabolic acidosis
H&H
UA - +protein, glucose, WBC, decreased urine osmolarity. Late
CKD – osmolarity increases.
Blood osmolarity / osmolality – decreased early and increased late
GFR
Renal US - atrophy, fibrosis
Biopsy
Xray - hand bones may show CKD- mineral bone disease (MBD)

19
Q

Meds

A

loop diuretics, thiazide diuretics, vitamins & minerals, erythropoietin stimulating agents, parathyroid hormone modulator, antihypertensive therapy (ACEi, ARBs, CCBs), statins to lower lipids, insulin may be decreased

20
Q

Why would insulin needs be decreased?

A

Kidneys excrete insulin and if they are not working, insulin sits in the body longer –> risk for hypoglycemia

21
Q

Dietary restrictions needed for severe kidney disease

A

Protein: 0.55-0.60g/kg/day
Fluid: depends on urine output but may be as high as 1500-3000mL/day
Potassium: 60-70mEq or mmol daily
Sodium: 1-3g/day
Phosphorus: 700mg/day

22
Q

Protein restriction is necessary in CKD.

Increased protein leads to increased protein breakdown and waste in the body. Kidneys are unable to remove the waste. Protein intake can’t go too low or other issues will occur.

A

Protein restriction early in CKD prevents some complications & may preserve kidney function.

Decreased protein leads muscle muscles wasting.

BUN & serum prealbumin levels are used to monitor adequacy of protein intake. Decreased prealbumin levels indicate poor protein intake.

23
Q

Food high & low in protein

A

High protein foods- red meats, poultry, fish/seafood, eggs, milk & cheese, beans, legumes, nuts, and soy

Low protein foods- fruits, veggies, grains (not whole grains), cereals

24
Q

Healthy kidneys control how much sodium is in your body. If your kidneys do not work well, too much sodium can cause fluid buildup, swelling, high BP, and strain the heart.

CKD patients should avoid foods high in sodium to prevent water retention and HTN.

What foods should be avoided?

A

No processed food, fast food, chips, pretzels, pickles, ham, bacon, sausage, and no salt substitutes.

25
Q

Potassium works with the muscles, including the heart. Too much or too little potassium in the blood can be dangerous. How much potassium you need is based on how well your kidneys are working and the meds you are taking.

High vs low potassium food examples

A

High- bananas, melons, oranges, kiwi, mango, dates, avocados, broccoli, brussels sprouts, sweet potatoes, pumpkin, spinach, black beans, lentils, legumes, milk, yogurt, nuts & seeds, chocolate, peanut butter

Low- apples, blueberries, grapes, peaches, raspberries, pineapple, asparagus, carrots, celery, cucumber, corn, green beans, lettuce, onions, rice, pasta, yellow cake, angel cake

26
Q

As kidney function gets lower, extra phosphorus can start building up in the blood. High phosphorus levels can cause bones to get weaker.

High vs low phosphorus food examples

A

High- dairy products, nuts, seeds, black beans, kidney beans, bran cereals, whole grain products, ale, beer, dark cola drinks

Low- fresh fruits and veggies, popcorn, crackers, rice cereal, sherbert/sorbet, coffee or tea, light colored sodas fruit juices

27
Q

Managing fluid volume in CKD/ESKD

A

Monitor for fluid overload (pulmonary edema), crackles in lungs, weight gain, balanced I&O

28
Q

Non-calcium phosphate binders reduce blood phosphate levels without disturbing calcium levels. Used to replace those lost through dialysis or poorly absorbed as a result of dietary restrictions.

** Ex: Sevelamer (Renagel) **

Reminders for the medication

A

-Take w/ meals
-Monitor both serum phosphorus and calcium levels (can cause hypercalcemia)
-Monitor for constipation
-Teach pt to report muscle weakness, slow/irregular pulse, or confusion –> hypophosphatemia

29
Q

Post Kidney transplant rejection signs

Hyperacute

A

onset within 24 hrs
Malaise, high fever, ^BP
Pain at transplant site
Organ must be removed

30
Q

Post Kidney transplant rejection signs

Acute

A

occurs within 6 months
oliguria, anuria
^temp over 100F
^BP
Flank tenderness
Lethargy
^BUN, K, Creatinine
Fluid retention

Not uncommon to have at least one rejection episode

31
Q

Post Kidney transplant rejection signs

Chronic

A

Gradual over months to years
Gradual ^ BUN, Creatinine
Imbalances in proteinuria electrolytes
Fatigue
Irreversible

Complex Health I (53 decks)

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