Chronic Kidney Disease/End Stage Kidney Disease FINAL Flashcards
GFR (kidney function) is used to stage
chronic kidney disease
eGFR considers creatinine levels, gender, race, and body size but it only used for screening & antibiotic/med dosing.
True or False
True
GFR > 90mL/min
At risk, normal kidney function but urine findings, structural abnormalities, or genetic trait points to kidney disease
Stage 1
GFR 60-89mL/min
Mild CKD; reduced kidney function; lab values and other findings point to kidney disease
Focus on reduction of risk factors
Stage 2
GFR 30-59mL/min
Moderate CKD
Implement strategies to slow disease progression
Stage 3
GFR 15-29mL/min
Severe CKD
Manage complications; Education on renal replacement therapy
Stage 4
GFR < 15mL/min
End stage kidney disease (ESKD)
Implement renal replacement therapy or kidney transplant
Stage 5
What is the leading cause of death in patients with ESKD?
CVD
Is CKD/ESKD reversible?
No. It is progressive, irreversible, w/no recovery.
S/Sx
- Uremia
- Azotemia
- Anuria
- Uremic fetor
- Stomatitis
- Halitosis
- Metallic taste in mouth/anorexia/nausea
- Polyuria
- Pruritis
- HTN
- Hyperlipidemia
- Anemia
- Increased risk of infection
Erythropoietin injections for
anemia
Erythropoietin stim agents reminders
Epoetin alfa
Should not be given when hemoglobin is greater than 13g/dL and pt is hypertensive
Manifestations of ESKD
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Psych: withdrawn, depressed, behavioral changes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
- 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
CKD-MBD (Mineral and Bone Disorder)/Renal Osteodystrophy
Risk factors for CKD
diabetes, hypertension, age>60, cardiovascular disease, family hx of CKD, exposure to nephrotoxic drugs, ethnic minority (African American, Native American)
Nephrotoxic drugs
antibiotics/antimicrobials, aminoglycoside antibiotics, chemotherapy agents, NSAIDs
Others- acetaminophen, metformin, pesticides, radiographic contrast medium, fungicides, arsenic, lead, copper sulfate, bismuth
Labs
Increased serum creatinine
Increased BUN
Decreased Na (hyponatremia)
Increased K (hyperkalemia)
Diagnostics
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)
Meds
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
Why would insulin needs be decreased?
Kidneys excrete insulin and if they are not working, insulin sits in the body longer –> risk for hypoglycemia
Dietary restrictions needed for severe kidney disease
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
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.
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.
Food high & low in protein
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
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?
No processed food, fast food, chips, pretzels, pickles, ham, bacon, sausage, and no salt substitutes.
