Chronic Renal Failure Flashcards
What is Chronic Renal Failure?
End-stage kidney failure
What can cause Chronic Renal Failure?
- May result from glomerular (RPGN, Nephrotic syndrome), tubular, inflammatory or vascular insults
- Can come from any compartment of the kidney
What are the three most common causes of Chronic Renal Failure?
- Diabetes Mellitus
- Hypertension
- Glomerular Disease
What can Chronic Renal Failure cause that leads to a constellation of symptoms?
Uremia!
What is Uremia?
Increased nitrogenous waste products in the blood (azotemia)
What does uremia cause?
- Nausea
- Anorexia
- Pericarditis
- Platelet dysfunction (inhibits adhesion and aggregation)
- Encephalopathy with asterixis (flapping hand tremor)
- Deposition of urea crystals in the skin
What causes HTN in Chronic Renal Failure?
Salt and water retention –> leads to resultant HTN
With Chronic Renal Failure, you can’t excrete K+ or get rid of organic acids. What does this cause?
- Hyperkalemia
- Metabolic acidosis with an anion gap
What causes anemia in Chronic Renal Failure?
Decreased Erythropoietin production by renal peritubular interstitial cells
What two things cause Hypocalcemia in CRF?
- Decreased 1-alpha-hydroxylation of vitamin D by proximal renal tubule cells
- Hyperphosphatemia
What causes hyperphosphatemia in CRF? How does this lead to hypocalcemia?
- Kidney is failing –> can’t excrete PO4-
- Inc. PO4- binds free Ca2+
- Causes Hypocalcemia
How does decreased 1-alpha hydroxylation of vitamin D cause hypocalcemia?
Vitamin D promotes absorption of Ca2+ so less Vitamin D leads to less Ca2+.
Where does 1-alpha hydroxylation of Vitamin D occur?
Proximal Renal Tubule Cells
What is renal osteodystrophy?
Bone damage caused by renal failure. It has 3 parts.
What are the three parts of osteodystrophy?
- Osteitis fibrosa cystica
- Osteomalacia
- Osteoporosis
What is Osteitis fibrosa cystic?
Hypocalcemia –> increased pH levels –> Reabsorption of Ca2+ in bone –> burn out bone –> fibrosis & cyst formation
What is Osteomalacia?
Body cannot mineralize osteoid made by osteoblasts. Osteoid needs to be mineralized with Ca2+ and phosphate. There is low Ca2+ due to low vitamin D.
What is Osteoporosis?
Leeching calcium from bone slowly over time
What does treatment for Chronic Renal Failure involve?
- Dialysis
2. Renal transplant
What often develops during dialysis?
Cysts in the kidney
What shows up in the kidney during dialysis for Chronic renal failure?
Cysts often develop within shrunken end-stage kidneys
What do the cysts that develop during dialysis increase a patients risk for?
RENAL CELL CARCINOMA!
