Chronic Renal Disease & Dialysis

Question 1

Define Chronic Kidney Disease

Answer 1

progressive loss of renal function persisting > 3 months

Question 2

What are the causes of Chronic Kidney Disease?

Answer 2

1. diabetes (37%)
2. HTN (24%)
3. Chronic glomerulnephritis
4. Polycystic kidney disease

Question 3

There is destruction/deterioration of the ___ with ___ to compensate. ___ is preserved until >50% nephron destruction.

Answer 3

nephrons; hypertrophy; homeostasis

Question 4

Patients are ___ with early disease but as the disease progresses ___ and ___ waste build up in the blood. How does this effect the kidney funciton?

Answer 4

asymptomatic; urea; nitrogenous

kidneys perform fewer excretory, endocrine, and metabolic functions

Question 5

What is the prinicpal marker of kidney damage?

Answer 5

protein

Question 6

What is the best measure of overall function?

Answer 6

glomerular filtration rate.

Question 7

___ filtration is a process by which the kidneys filter blood to remove excess waste and fluid.

___ is a calculation to determine how well the blood is filtered by the kidneys.

Answer 7

glomerular; GFR

Question 8

Describe and list the GFR for chronic kidney disease (CKD) stage 1 and 5.

Answer 8

stage 1: damage w/normal GFR (≥90)

stage 5: kidney failure w/GFR (less than 15 or dialysis)

Question 9

___ care is given to stage 1 and 2 CKD (GFR > ___).

Describe the care.

Answer 9

Conservative care; >60

• Decrease nitrogenous waste retention (dietary modification)
• Control HTN, fluids, electrolyte imbalance (limiting fluid, sodium, potassium intake)
• Correct/control diabetes, HTN, CHF, hyperparathyroidism

Question 10

With chronic ambulatory peritoneal dialysis (CAPD) ___ solution is injected into the peritoneal cavity through a permanent ___. The solution and dissolved solutes (urea) are drawn out.

How often is this performed?

Answer 10

HYPERtonic; catheter

4-5 DAILY sessions (30-45 minutes each)

Question 11

What are some advantages to peritoneal dialysis? Disadvantages? Indications?

Answer 11

advantages:
Low cost
Easy to perform
No anticoagulation

Disadvantages:
Frequent sessions
Peritonitis
Lower effectiveness than hemodialysis

Indications:
Acute renal failure
occasional dialysis

Question 12

When is hemodialysis indicated?

How is hemodialysis done?

Answer 12

▸ Indications: GFR less than 15
▸ Every 2-3 days, 3-4 hours per session
▸ Normal life (relatively) between sessions

Question 13

T/F. Hemodialysis is lifesaving and provides 90% of normal renal function.

Answer 13

False, Hemodialysis is lifesaving and provides 15% of normal renal function.

Question 14

Describe how hemodialysis is performed.

Answer 14

“Plugged-in” to machine
AV fistula are surgically created in the forearm
good access
good blow flow

Question 15

What is the most common complication of hemodialysis? How is this treated?

Answer 15

anemia is treated with recombinant human erythropoietin

Question 16

Other than anemia, ___ serum calicum, possible infection of the ___ ___, and bleeding tendencies are all complications of hemodialysis.

Answer 16

decreased; AV fistula

Question 17

T/F. Infections of the AV fistula that lead to possible septicemia and IE are caused by Strep.

Answer 17

False, Infections of the AV fistula that lead to possible septicemia and IE are caused by STAPH.

Question 18

T/F. Because infections can arise in the AV fistula following hemodialysis, these patients should receive prophylaxsis.

Answer 18

False, No IE prophylaxis for dental/oral surgery procedures.

Question 19

T/F. There are no contraindications for routine care however, a physician consult may be needed if patient is ≥ stage 4 CKD.

Answer 19

True.

Question 20

Avoid/adjust dosage of nephrotoxic drugs and those excreted by the kidneys if GFR is less than ___. ___ is given for post-op analgesia.

Answer 20

60; acetaminophen

Question 21

T/F. Dental treatment on days between dialysis.

Answer 21

True

Question 22

Why should you obtain a platelet count if surgery is needed?

Answer 22

platelet destruction by machine

Question 23

T/F. Use the arm with the AV shunt to obtain BP and provide these patients with antibiotic prophylaxis.

Answer 23

False, no BP cuff, no antibiotic prophylaxis