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Gen Med Unit 4 > Chronic Renal Failure > Flashcards

Chronic Renal Failure Flashcards

1
Q

Stage 1 of CKD

A
  1. Kidney damage (protein in urine)
  2. Normal GFR >/= to 90
  3. Function: 50-60%
  4. No symptoms
  5. Tx comorbidities
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2
Q

Stage 2 of CKD

A
  1. Kidney damage (protein in urine)
  2. Decreased GFR: 60-89
  3. Function: 60-70%
  4. No symptoms
  5. Glucose control
  6. BP <130/80 through use of ARB or ACE inhibitor
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3
Q

Stage 3 of CKD

A
  1. Moderate renal damage
  2. GFR: 30-59
  3. Refer to nephrologist
  4. Manage anemia, malnutrition, bone disease as well as BP
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4
Q

Stage 4 of CKD

A
  1. Severe damage
  2. GFR 15-29
    3, Symptoms: Fatigue, Insomnia
    Difficulty concentrating,
    Edema (face and feet)
    Itching (uremic pruritis)
    Dialysis education
    Dialysis access
    Transplant education
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5
Q

Stage 5 of CKD

A
  1. Kidney Failure
  2. GFR < 15 mL/min or on dialysis
    More severe fluid retention
    Anorexic
    Declining mental function
    Peripheral neuropathy
    Treat with dialysis or transplant
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6
Q

What % loss of glomerular filtration correlates to symptom development?

A

75% loss of glomerular filtration

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7
Q

CKD Definition

A
  1. Progressive, irreversible loss of nephrons and nephron function which takes place over months to years
  2. GFR months
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8
Q

What is the leading cause of morbidity and mortality for CKD?

A
  1. Cardiovascular, including: CAD/PVD/Cerebral VD, HTN, CHF, LVH, pericarditis
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9
Q

What are the skin symptoms seen with CKD?

A

Yellow-brown color, dry & scaly skin, brittle nails, severe itching

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10
Q

What are the neurologic symptoms seen with CDK?

A

Altered mental status, muscle cramps and twitching, paresthesias, muscle wasting

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11
Q

What are the endocrine symptoms seen with CKD?

A

Secondary hyperparathyroidism

Anemia (erythropoietin deficiency)

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12
Q

What are the hematologic symptoms seen in CKD?

A

GI bleeding, easy ?bruising, bleeding from body orifices

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13
Q

What are the MSK symptoms seen in CKD?

A

Fractures, bone & muscle pain, abnormal gait

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14
Q

Why is calcitriol important in CKD?

A

Calcium in cells in dropping, so calcitriol is increased to cause increased absorption of ca in the intestine and increased release of Ca in ECF

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15
Q

Diagnostic Studies in CKD: CBC results

A
  1. Low Hgb/Hct
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16
Q

Diagnostic Studies in CKD: Renal function

A
  1. Increased BUN and Cr
17
Q

Diagnostic Studies in CKD: Electrolytes results

A

Hyperkalemia
Hypocalcemia
Hyperphosphatemia

18
Q

Diagnostic Studies in CKD: ABG results

A

Metabolic acidosis

19
Q

Diagnostic Studies in CKD: UA results

A

Specific gravity low

Proteinuria, glycosuria, RBC’s, casts, crystals, WBC’s

20
Q

Diagnostic Studies in CKD: Imaging studies results

A

Reduced kidney size (<9-10 cm)

Enlarged in PKD, Diabetic Neph., Mult. Myeloma, Amyloidosis, Obstructive Neph.

21
Q

Diagnostic Studies in CKD: renal biopsy results

A

Identify underlying disease

22
Q

Conservative Tx of CKD

A
  1. Low protein diet to reduce end products of protein metabolism
  2. High calorie diet to prevent ketoacidosis
    Na+ & K+ restrictions
  3. Phosphorous restriction
    4 Fluid restriction to maintain fluid balance: esp. dialysis pts
23
Q

Drug therapies for CKD

A
  1. Loop diuretics (furosemide/Lasix)
  2. Anti-hypertensives
    ACE inhibitor or ARB
    Diuretic should be added
  3. Anti-emetics prn
  4. Stool softeners prn
  5. Iron and folate supplements prn
  6. Synthetic erythropoietin – Epogen/Procrit
24
Q

Procedural tx of CKD

A
  1. Dialysis
    A. Hemodialysis
    Filters blood through dialysis machine via AV fistula
    B. Peritoneal dialysis
    Catheter is placed in peritoneal cavity for instillation of dialysate
25
Q

Tx of Hyperkalemia: Emergent

A
  1. Emergency Measures (EKG changes)
    A. Hyperkalemia (>6.5 mEq/L)
    - Regular insulin 10 cc IV + 50% Dextrose 50 cc IV
    Facilitates uptake of glucose into the cell, which brings potassium with it. Give dextrose to replace the glucose that was taken up into the cells
    -HCO3 IV
    Give if acidotic
    ↑ pH, resulting in temporary potassium shift from the extracellular to intracellular. Use as adjunct to insulin
    B. Dialysis: if a dialysis pt
    C. Pericardiocentesis:
    Cardiac tamponade
    D. Thoracentesis:
    Relieve pulmonary edema and pleural effusion
26
Q

Tx of Hyperkalemia: non-emergent

A
  1. Non-emergent measures (No EKG changes)
  2. Loop Diuretics (Lasix/furosemide)
    Cause potassium loss through the kidney
  3. Beta 2-adrenergic agonist (Albuterol)
    Promote cellular reuptake of potassium
  4. Exchange Resin (Kayexalate)
    Exchanges Na+ for K+ (binds) and evacuates with BM
27
Q

What ethnic groups are more prone to CKD?

A

Hispanics, African-Americans, Asians, and Native Americans

28
Q

What age group is CKD most commonly seen in?

A

> 60 yr

29
Q

What vascular diseases can lead to CKD?

A

HTN, Renal artery stenosis

30
Q

What primary chronic glomerular diseases can lead to CKD?

A

IgA nephropathy: common, many improve but some turn chronic

31
Q

What secondary chronic glomerular diseases can lead to CKD?

A
  1. Collagen-vascular disease (SLE, Sarcoidosis, etc.)
  2. Postinfectious glomerulonephritis
  3. Diabetic nephropathy
    Most common cause in U.S. & other developed countries
32
Q

What tubulointestinal nephritic disorders can lead to CKD?

A

Drugs, heavy metals, chronic pyelonephritis

33
Q

What 2 misc disease can lead to CKD?

A

Polycystic kidney disease

Obstructive nephropathy: postrenal obstructions not taken care of

34
Q

Pathophys of CKD

A

Decreased renal function interferes with the kidneys’ ability to maintain fluid and electrolyte homeostasis

Decreased ability to excrete phosphate & K+

When renal failure is advanced (GFR ≤ 10 mL/min) the ability to concentrate urine is lost

35
Q

What 3 parameters is CrCl affected by?

A

Age
Muscle mass
High protein diet

36
Q

The amount of filtrate produced by the kidney depends on…

A

Amount of blood flow to kidney

Ability of glomeruli to filter

37
Q

Complications from CKD

A
  1. Proteinuria: not immediately, but soon after disease starts
  2. HTN
    Most common physical finding in CKD
  3. CV disease: due to underlying HTN
  4. Decreased renal function can lead to uremia
    Accumulation of nitrogenous wastes (urea) from protein metabolism (azotemia)
    Accompanies loss of fluid and electrolyte balance
38
Q

What are the systemic effects of uremia?

A 
Extracellular fluid accumulation
Low Caˉ, high K+
Acidosis (metabolic)
Anemia/bleeding disorders
Osteomalacia (soft bones): due to high phosphorus and low calcium, PTH also plays a role
CAD/PVD/CVA
Encephalopathy, seizures, peripheral neuropathy
Pruritis/yellow skin 
Secondary to uremia

Gen Med Unit 4 (7 decks)

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