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Clin Med III Exam II > Chronic Renal Failure > Flashcards

Chronic Renal Failure Flashcards

1
Q

Which races are more likely to experience kidney failure

A

african americans and hispanics

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2
Q

What classifies chronic kidney disease

A

progressive loss of renal function that persists for more than 3 months

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3
Q

What is the function of the kidney

A

“A WET BED”

  • acid base regulation
  • water regulation
  • electrolyte balance
  • toxin elimination
  • BP regulation
  • erythropoetin
  • vitamin D
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4
Q

What two things need to be present for a diagnosis for CKD?

A
  • GFR <60 mL/min for more than 3 months

- persistence of proteinuria/hematuria/abnormal urinary sediment

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5
Q

CKD casues what? Which leads to the inability to maintain what functions?

A

leads to progressive nephrosclerosis, irreversible reduction in nephron number

inability to maintain:

  • acid base balance
  • fluid and electrolyte balance
  • excretion of nitrogenous waste
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6
Q

What is the pathophys of CKD

A

hyperfiltration and nephron damage–> hypertrophy of remaining nephrons–> distortion of glomerular architecture and sclerosis of nephrons

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7
Q

Nephron injury=

A

loss of functioning unit

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8
Q

What is the consequence of hyperfiltration

A

glomerular capillary hypertension

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9
Q

What two things are activated to maintain GFR w/ hyperfiltration

A

RAAS and AII

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10
Q

What is the complication of constant activation of AII

A

pore size altered–>protein leak across basement membrane–> increased glomerular permeability adn excessive protein filtration

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11
Q

What is the consequence of continued activation of the RAAS

A

microalbuminuria/proteinuria

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12
Q

How does proteinuria contribute to CKD

A
  • proteins clog the tubules

- proteins are toxic and cause tubular injury, tubulointerstitial inflammation and scarring

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13
Q

What is GFR a measure of

A

how well the kidneys are removing wasted and excess fluid from the blood

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14
Q

How is GFR calculated

A

from the serum creatinine level using age, weight, gender and body size

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15
Q

What is a normal GFR

A

above 90

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16
Q

What GFR indicates the kidneys are not working properly

A

60

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17
Q

What GFR would indicate kidney failure

A

below 15

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18
Q

When do sx of CKD typically develop

A

stage 3 or 4

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19
Q

What are the sx of CKD

A
  • anemia
  • fatigue/weakness
  • decreased appetite
  • N/V
  • encephalopathy
  • muscle twitches, cramps
  • swelling of feet/ankles
  • pruritis
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20
Q

What is uremic syndrome

A

symptomatic manifestations associated with azotemia

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21
Q

What is azotemia

A

the accumulation of urea and other nitrogenous compounds and toxins caused by the decline in renal function

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22
Q

What complications can present with chronic kidney disease

A
  • anemia
  • metabolic acidosis
  • derangements in vit D, calcium and phosphorus metabolism
  • volume overload
  • hyperkalemia
  • uremia
  • cardiovascular consequences
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23
Q

Labs in CKD

A
  • elevated BUN/creatinine
  • hyperkalemia
  • hyperphosphatemia
  • hypocalcemia
  • proteinuria
  • RBC/WBC/casts in urine
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24
Q

What is creatinine

A

waste product that develops from normal wear and tear on the body muscles produced at a fairly constant rate and excreted unchanged by the kidneys

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25
What creatinine levels are can early sign that the kidneys arent working
greater than 1.2 in women and 1.4 in men
26
What is the relationship between kidney function and creatinine
as kidney function decreases, creatinine rises
27
What does BUN measure
the amount of nitrogen in your blood that comes from the waste product urea
28
What is a normal BUN
between 7 and 20
29
What is the relationship between BUN and kidney function
as kidney function decreases, BUN levels rises
30
What is considered microalbuminuria
30-300mg/L
31
What is considered macro albuminuria
>300 mg/L
32
What classifies hematuria
>3 RBCs per high power field on at least two occasions
33
What does 1-2 g/24hr of protein found in urine indicate
underlying kidney abnormlaity, typically glomerular
34
If >3.5 g/24hr of protein is found in the urine what does that tell you
nephrotic syndrome
35
Why does anemia occur in CKD
secondary to decreased EPO
36
When should EPO stimulating agents to provided in CKD
if Hgb falls below 10
37
Why does metabolic acidosis occur in CKD
secondary to decreased bicarb reabsorption and generation by kidneys
38
When do you treat metabolic acidosis in CKD
give bicarb supplementation when bicarb falls below 18
39
Why does vitamin D deficiency occur in CKD
secondary to decreased production of 1,25-OH vitamin D b/c kidney is responsible for hydroxylation of active form
40
Why does bone disease occure in CKD
secondary to abnomrlaities in the complex interaction between vitamin D, phosphorus, calcium and PTH
41
What are risk factors for developing CKD
- hypertension - DM - autoimmune disease - advanced age - previous episode of AKI - structural abnormalities of urinary tract
42
At what stage CKD should your patient be seen by a nephrologist
stage 4 and 5
43
What complications come along with stage 4 CKD
- difficult to control HTN - difficult to control edema - hyperkalemia - uremia
44
What do most stage 5 CKD pateitns die from
cardiovascular disease (MI and CVA)
45
What patients reach stage 5 CKD what do they need
kidney transplant or they die
46
What are the most common causes of end stage renal disease
- diabetic glomerular disease | - hypertensive nephropathy
47
What is the target A1c to prevent the progression of CKD
<7
48
How does DM cause kidney injury
blood glucose rises above the capacity of kidney to reabsorb it-->raises osmotic pressure-->more water to be carried out and urine output increased
49
What is the blood pressure goal for patients with diabetes? What does blood pressure control do?
<130/80, it delays the onset of microalbuminuria
50
What is the first sign of diabetic nephropathy
microalbuminuria
51
Treatment for diabetic nephropathy
ACE/ARB and diuretic (blood pressure control)
52
Treatment of HTN
- 2 to 4 gram salt restriction - weight loss - rxn
53
Who does hypertensive nephropathy develop in
pts with proteinuria and hypertension
54
How are ACE/ARBs renal protective
reduce glomerular permeability to proteins--> limits proteinuria and decrease glomerular intra capillary pressure
55
When do you refer patients to nephrologist
- GFR <30 - rapidly progressive CKD - poorly controlled HTN - rare or genetic causes of CKD - suspected renal artery stenosis
56
How does hemodialysis work
blood is pumped through a semipermiable membrane and a pressure gradient is created that causes water and dissolved solutes to move from the blood to the dialysate
57
What types of access points are used for dialysis
- AV fistula | - dialysis catheter
58
What is peritoneal dialysis
dialysate is run though a tube into the peritoneal cavity where the peritoneal membrane of the intestine acts as a patrially permeable membrane and waste products are removed
59
What is the indication for a kidney transplant
end stage renal disease regardless of the primary cause (GFR <15)
60
Where does the healthy kidney get placed when being transplanted
in the lower abdomen
61
When is a kidney-pancreas transplant indicated
a patient that has kidney failure related to type 1 diabetes
62
Are pateitns with type 2 diabetes eligible for a kidney-pancreas transplant? Why or why not?
No because the pancreas makes insulin the body is just resistant to it

Clin Med III Exam II (11 decks)

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