Chronic Renal Failure Flashcards
Does chronic kidney disease often go without symptoms (especially at early stages)?
YES and is not diagnosed without a lab test (serum creatinine and GFR determination).
What is the difference between azotemia and uremia?
- azotemia is just the lab for increased blood urea nitrogen (BUN).
- uremia is the lab value plus symptoms.
- What is the definition of chronic kidney disease?
kidney damage for > 3 months, as defined by structural or functional abnormalities +/- decreased GFR, manifest by either pathologic abnormalities, markers of kidney damage, or GFR
** What are the stages of chronic kidney disease?
TEST QUESTION
Stage 1= GFR > 90 (normal GFR) but have functional abnormality. Stage 2= GFR 60-89 Stage 3= GFR 30-59 Stage 4= GFR 15-29 Stage 5 (renal failure)= GFR
REMEMBER: what is GFR?
GFR= urine x volume/ plasma
Do subtle changes in serum creatinine at early stages of CKD mean more or less?
MORE because if your GFR were to go from 1 to 1.5, your GFR would go from 90 to 60!
What is the workup for a pt suspected to have CKD besides GFR?
- previous creatinine values
- rule out reversible causes (urinary obstruction…)
- electrolytes (rule out tubular disorders)
- urinalysis (urine sediment for blood, protein, casts)
- ultrasound
- URINE ALBUMIN:CREATININE RATIO (spot is more effective than 24 hour).
- kidney biopsy
What is albumin just as important for risk stratification?
it is and independent risk factor CVD
**Why do pts get CKD and why do they start dialysis?
- DM
2. HTN
** What is APOL-1?
gene associated with African Americans and is though to provide resistance to trypanosomes but functional significance to the kidney is still not known, but is thought to increase risk for end stage renal disease!
***What is the main manifestation of CKD?
CVD. Most pts die from this before they reach end-stage kidney disease. So the name of the game is to improve their cardiovascular health!
What symptoms will we see in stage 4 CKD?
fatigue, swelling, nausea, vomiting…but again these are non-specific :(
What is chronic kidney disease- mineral and bone disorder (CKD-MBD)?
collective grouping of laboratory abnormalities, bone abnormalities, and vascular calcification leading to CVD, fractures and mortality.
What are the hematologic/GI manifestations of late stage CKD?
- anemia (decreased EPO production)
- platelet dysfunction (bleeding tendencies)
- nausea/vomiting
- uremic fetor
- metallic taste
- anorexia, malnutrition
- stomatitis, parotitis
- gastritis, enterocolitis
Will you see an acidosis or alkalosis with later stage CKD?
- acidosis due to the inability to clear sulfates, phosphates…
- bone will try to buffer hydrogen ions at expense of calcium and phosphorus.
What are the goals of treatment for stage 3 CKD (GFR
- treat reversible causes
- slow/halt progression
- manage associated disorders of CKD
- identify and adequately prepare pt for renal replacement therapy; stage 4.
How do we slow the rate of progression?
- control BP (
Should you ever have a pt on an ACE and an ARB?
NO!!! Caused HYPERkalemia
What is the HgbA1c goal for slowing the rate of CKD progression in diabetics?
How do we manage associated disorders of CKD?
smoking cessation, exercise, nutrition (
How do we treat the acid/base disturbance?
sodium bicarbonate
What are the 3 options for renal replacement?
- hemodialysis
- peritoneal dialysis
- kidney transplant
What is the difference between a fistula and a graft for hemodialysis access?
- radio-cephalic fistula= connection of your vein to your artery.
- loop graft= piece of teflon tubing connects artery and vein.
When do you need to start dialysis (renal replacement therapy) right away when GFR is below 15?
- pericarditis or pleuritis (“rub”)
- progressive encephalopathy/neuropathy
- fluid overload refractory (not responding) to diuretics
- bleeding due to uremia
- HTN uncontrolled with medications
** When does planning for renal replacement begin?
at stage 4 CKD
** What option for renal replacement confers the highest survival benefit among all 3?
TRANSPLANT! :)
