chronic renal failure

Question 1

chronic renal failure

Answer 1

progessive, irreversible damage to the nephrons and glomeruli

Question 2

causes of CRF

Answer 2

recurrent kidney infections, vascular changes (dm, htn) may be diffuse or limited to one kidney

Question 3

regardless of the cause:

Answer 3

decreased: GFR, tubular reabsorption capabilities. Dysfunction fluids and electrolytes, acid base disturbances, & systemic problems develops

Question 4

End stage renal disease

Answer 4

• protein and waster metabolism accumulates in the blood (azotemia)
• 90% of kidney function is lost (kidney cannot adequately function)
• hypothesis: nephrons remains intact, others progressively destroyed
• adaptive response maintains function until 3/4 are destroyed
• hypertrophy continues-> kidneys begin to lose their ability to concentrate the urine adequately
• polyuria is perhaps early sign of ESRD
• as disease progresses unable to rid body of excess water products via the kidneys- uremia results-eventually other systems affected.
• other sxs: nocturia, oliguria, increased k, mg, po4 and decrease ca, neuro changes, CV changes etc.

Question 5

stages of crf

Answer 5

diminished renal reserve: Normal BUN, and serum creatinine absence of symptoms.
renal insufficiency: GFR is about 25% of normal , BUN creatinine levels increased
Renal failure: GFR <5-10 ml/min

Question 6

treatment modalities

Answer 6

• decrease fluid 1000 ml/day
• decrease protein (.5-1 kg body weight)
• decrease sodium (1-4 gm variable)
• decrease k
• decrease phosphorous (<1000 mg/day)
• dialysis (peritoneal, hemodialysis)
• RBC, vitamin D (calcitrol replacement) etc

Question 7

hemodialyis

Answer 7

move substances from blood through a semi permeable membrane and into a dialysis solution

Question 8

peritoneal dialysis

Answer 8

peritoneal membrane is the semi permeable membrane
catheter placement-anterior ab wall. tenckoff (25 cm length with cuff anchor and migration) Dialysis solution (1-2 L sometimes smaller)
Three phases of PD
-inflow aprox 10 min, could be in cycles
-dwell (equilibration) (approx 20-30 min or 8+hours)
-drain (approx 15 min)
three phases called exchanges

Question 9

advantages of PD

Answer 9

immediate initiation 
less complicated
portable
fewer dietary restrictions
short training time
less cardio stress
choice for diabetics

Question 10

disadvantages of PD

Answer 10

bacterial/chemical peritonitis 
protein loss
exit site of catheter
self image
hyperglycemia
surgical placement of catheter
multiple abdominal surgery

Question 11

advantages of hemodyalysis

Answer 11

rapid fluid removal
rapid removal of urea and creatinine
effective k removal
less protein loss
lower triglycerides
home dialysis possible
temporary access at the bedside

Question 12

disadvantages of hemodyalysis

Answer 12

vascular access problems
dietary and fluid restrictions
heparinization
extensive equipment
hypotension
added blood loss
trained specialist