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Clin Med- Renal/GU > Chronic Renal Failure > Flashcards

Chronic Renal Failure Flashcards

1
Q

What is acute kidney disease

A

Rapid loss of kidney function
Commonly reversible
Usually caused by dehydration, blood loss, medication, IV contrast, obstruction

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2
Q

What is chronic kidney disease

A

Progressive loss of renal function that persists for more than 3 months
Commonly irreversible
Usually caused by long-term diseases such as DM, HTN

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3
Q

Chronic kidney disease results in an inability to maintain what?

A

Acid-base balance
Fluid and electrolyte balance
Excretion of nitrogenous wastes

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4
Q

3 major renal processes

A

Glomerular filtration
Tubular reabsorption
Tubular secretion

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5
Q

What does the afferent arteriole do?

A

carrying blood to the glomerular capillaries

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6
Q

what does the efferent arteriole do?

A

carrying blood from the glomerular capillaries

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7
Q

Epidemiology of Chronic Kidney Disease

A

800,000 Americans have CKD
20 Million people in the US are at risk for CKD
Kidney disease kills over 90,000 Americans every year
blacks 3x more likely
hispanic 1 1/2 times more likely

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8
Q

Transplant statistics

A

Of 118,000 Americans currently on the waiting list for a lifesaving organ transplant, more than 96,000 need a kidney, Fewer than 17,000 people receive one each year
Every day 13 people die waiting for a kidney
Approximately 415,000 Americans are on dialysis and approximately 180,000 live with a functioning kidney transplant

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9
Q

What happens during chronic kidney disease?

A

Progressive loss of renal function associated with systemic diseases
As the disease progresses, the glomerular filtration rate decreases

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10
Q

Glomerular Filtration Rate (GFR) is what?

A

Measure of how well the kidneys are removing wastes and excess fluid from the blood
The normal value for GFR is 90 or above

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11
Q

A GFR below 60 is a sign of what?

A

is a sign that the kidneys are not working properly

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12
Q

a GFR below 15 indicated what?

A

indicates that a treatment plan for kidney failure, such as dialysis or a kidney transplant is needed

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13
Q

2 ways to calculate GFR?

A

MDRD equation

Cockcroft-Gault equation

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14
Q

Clinical Manifestations for CKD

A

asymptomatic
frost
uremic syndrome
azotemia

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15
Q

What is frost?

A

when urea is excreted by sweating, it crystallizes on the skin

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16
Q

What is azotemia?

A

Increase levels of serum urea, serum creatinine and other nitrogenous compounds related to decreasing kidney function

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17
Q

What is uremic syndrome

A

accumulation of urea and other nitrogenous compounds and toxins caused by the decline in renal function
occurs once GFR < 10-20ml/min, when adaptive renal reserves have been exhausted

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18
Q

Labs associated with CKD

A 
Proteinuria 
Red blood cell / cast 
White blood cell /cast
Elevated BUN (7 to 20 mg/dL)
Elevated Creatinine (0.8 to 1.4 mg/dL)
Hyperkalemia (3.7 to 5.2 mEq/L)
Hyperphosphatemia (2.4 - 4.1 mg/dL)
Hypocalcemia (8.5 to 10.2 mg/dL)
Metabolic Acidosis
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19
Q

At least 3 hypotheses have been proposed to explain the pathogenesis of the hypocalcemia

A

Phosphate retention
Skeletal muscle resistance to the calcemic action of parathyroid hormone
Altered vitamin D metabolism

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20
Q

What is serum creatinine?

A

Waste product that develops from normal wear and tear on the body muscles

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21
Q

Approximate normal levels of serum creatinine?

A

A creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly

As kidney function decreases, creatinine level rises

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22
Q

BUN measures what?

A

Measures the amount of nitrogen in your blood that comes from the waste product urea
As kidney function decreases, the BUN level rises

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23
Q

Urea is made when?

A

Urea is made when protein is broken down in your body.

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24
Q

24 hour urine test compares what?

A

Compares the urine creatinine to the blood creatinine to show how much blood the kidneys are filtering out each minute

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25
Q

Filtration of blood and protein

A

As blood passes through healthy kidneys, they filter out the waste products and leave in the things the body needs, like albumin and other proteins. Most proteins are too big to pass through the kidneys’ filters into the urine. However, proteins from the blood can leak into the urine when the filters of the kidney are damaged.

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26
Q

what is the main protein in the blood?

A

albumin

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27
Q

Why are proteins important?

A

building blocks for all body parts, including muscles, bones, hair, and nails.
Proteins in the blood also perform a number of important functions including keeping the right amount of fluid circulating in the intravascular space preventing edema

28
Q

Microalbuminuria

A

occurs when the kidney leaks small amounts of albumin into the urine
Trace – 1+ on dipstick mg/dL
30-300mg/L (spot) or 30-300mg/24hrs (24hr collection)

29
Q

What are 3 diagnostic studies fo CKD?

A

EKG changes due to electrolyte abnormalities
Echogenicity – diffuse changes, usually refers to possible glomerulonephric degeneration, damage to the glomerulus and nephrons, can be due to DM and HTN
Ultrasound may show small echogenic kidneys bilaterally

30
Q

Factors to Monitor in the Progression of CKD (7)

A 
Proteinuria  
Creatinine and BUN levels
Sodium and Water Balance
Phosphate and Calcium Balance
Hematocrit level
Potassium level
Acid-Base Balance
With a CBC, Chem7, UA
31
Q

Aldosterone helps to regulate what? (3)

A

Blood Volume
Blood Pressure
Electrolyte Balance

32
Q

What happens with an increase of aldosterone?

A

Increased Na/Water reabsorption
increased blood volume
increased BP

33
Q

What is the consequence of hyperfiltration?

A

glomerular capillary hypertension (causes further injury)

starts the RAAS cycle

34
Q

What does nephron injury lead to?

A

hyperfiltration and loss of functioning units

35
Q

Efferent arteriole vasoconstriction

A

causes the stimulation of RAAS which again initiates the cycle to increase blood volume and blood pressure, causing further glomerular injury by increase capillary pressure

36
Q

Albuminuria/Proteinuria

A

Excess protein in the urine contributes to progressive kidney damage
Proteins present in the urine are toxic to the tubules, and result in tubular injury, tubulointerstitial inflammation, and scarring

37
Q

Risk Factors to the development of CKD

A

Diabetes*
Hypertension*
Obstructive Nephropathies
Vascular diseases

38
Q

Epidemiology of DM and CKD

A

Leading cause of ESRD (end stage renal disease)
Nearly 26 million Americans have diabetes
More than 224,000 have CKD caused by DM
Intensive insulin therapy to maintain hbA1c level <7.0% reduces progression of kidney disease

39
Q

Why does DM cause chronic kidney disease

A

Damages vessels in the kidney
Elevated blood glucose rises beyond kidneys capacity to reabsorb glucose
Glucose remains diluted in the fluid, raising its osmotic pressure and causing more water to be carried out, increasing urine volume

40
Q

Increased urine volume dilutes what?

A

sodium chloride, signaling the kidney to release more renin, causing vasoconstriction, a survival mechanism to retain water by passing less blood through the kidneys

41
Q

treatment for DM causing CKD

A

Tight glucose control

Diet/exercise

*BP control <140/90, lowering the BP delays the onset of microalbuminuria

42
Q

First sign of diabetic nephropathy in a patient with DM?

A

Diabetic patient with the development of renal injury

microalbuminuria

43
Q

Most common comorbidity with diabetic nephropathy

A

HTN

44
Q

Recommended treatment for diabetic nephropathy?

A

ACEI/ARB treatment even in a normotensive patient with Diabetic Nephropathy due to renal protective properties
Diuretics

45
Q

HTN causing CKD Epidemiology?

A

Second leading cause of ESRD
HTN accelerates the progression of CKD
Controlling blood pressure slows down the decline in GFR
Inhibiting RAAS is effective in lowering blood pressure and reducing microalbumiuria

46
Q

What does BP measure?

A

measures the force of blood against the walls of the blood vessels, extra fluid, narrow, stiff or clogged vessels increase blood pressure

47
Q

How would you treat HTN causing CKD?

A

Salt and water restriction
2-4g/d salt restriction to avoid CHF/edema

Weight loss

Pharmacological therapies

48
Q

When does hypertensive nephropathy occur?

A

Develops in patients with proteinuria and hypertension

49
Q

Treatment for Hypertensive nephropathy

A

ACE inhibitors and ARBs reduce the glomerular permeability barrier to proteins and limit proteinuria and filtered protein-dependent inflammatory signals, and decrease glomerular intra capillary pressure
stages 1-3 and those with proteinuria

50
Q

What should you expect to see with ACE/ ARBs in regard to GFR?

A

Expect worsening creatinine up to 30% or reduction of GFR of 20% from baseline, if values stabilized after initial rise then its safe to continue

If values continue to rise then ACEI/ARBS’s need to be discontinued and consult a Nephrologist

51
Q

What should you expect to see with ACE/ARB in regards to hyperkalemia?

A

Contribution to hyperkalemia, >6.0mmol/L, then stop any other harmful drugs, reduce or hold potassium retaining diuretics, reduce loop diuretic dosage

If hyperkalemia continues stop ACEI/ARB

52
Q

What should be monitored with ACE/ ARBS?

A

Monitor serum creatinine and potassium concentration prior to initiation of drug, within 2 weeks of starting the drug and within 2 weeks after subsequent increases in does

53
Q

When should nephrologist be consulted?

A

Patients with stages 4 & 5 CKD require a Nephrologist consult for initiation of treatment with an ACEI/ARB

54
Q

Contraindications for ACE/ ARBs

A

previous angioedema with ACEI/ARB’s, renal artery stenosis

Pregnancy category D: should be avoided in women who are likely to become pregnant

55
Q

common adverse effects of ACE/ ARBs

A

hypotension, cough(ACEI), hyperkalemia, headache, dizziness, fatigue, nausea

56
Q

Cyclic relationship between CKD and HTN

A
  • -CKD is a risk factor for cardiovascular disease
  • -Reduced GFR and proteinuria are independently associated with an increase in cardiovascular mortality
  • -Elevated BP leads to damage of blood vessels within the kidney and throughout the body
  • -Patients with CKD and HTN often experience fluid retention or fluid overload. As a result, diuretics are often necessary in their treatment regimen
57
Q

4 CKD treatment

A

Primary Prevention
Treat underlying disorder
Dialysis
Transplant

58
Q

when to refer to a nephrologist (5)

A 
GFR < 30ml/min (CKD Stages 4 and 5)
Rapidly progressive CKD 
Poorly controlled hypertension despite four agents
Rare or genetic causes of CKD
Suspected renal artery stenosis
59
Q

What is dialysis?

A

Process for removing waste and excess water from the blood, and is used primarily as an artificial replacement for lost kidney function in people with ARF or CKD

60
Q

Process of hemodialysis?

A

Patient’s blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane
The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable membrane
Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions
The cleansed blood is then returned via the circuit back to the body

61
Q

Ultrafiltration occurs by what?

A

increasing the hydrostatic pressure across the dialyzer membrane
done by applying a negative pressure to the dialysate compartment of the dialyzer
This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several liters of excess fluid

62
Q

Peritoneal Dialysis

A

is carried out at home by the patient, often without help (nothing really invasive about it)**
** happens about 4-5 times a day
This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week
Peritoneal dialysis can be performed with little to no specialized equipment

63
Q

Process of peritoneal dialysis

A

a sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane

64
Q

Indication for kidney transplant?

A

Indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause
This is defined as a glomerular filtration rate <15m

65
Q

What are some problems with transplantation?

A

transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient

66
Q

Who are not candidates for kidney- pancreas transplants?

A

type 2 diabetes are not candidates for a combined kidney-pancreas transplant

Clin Med- Renal/GU (7 decks)

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