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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
Q

What creatinine levels are can early sign that the kidneys arent working

A

greater than 1.2 in women and 1.4 in men

26
Q

What is the relationship between kidney function and creatinine

A

as kidney function decreases, creatinine rises

27
Q

What does BUN measure

A

the amount of nitrogen in your blood that comes from the waste product urea

28
Q

What is a normal BUN

A

between 7 and 20

29
Q

What is the relationship between BUN and kidney function

A

as kidney function decreases, BUN levels rises

30
Q

What is considered microalbuminuria

A

30-300mg/L

31
Q

What is considered macro albuminuria

A

> 300 mg/L

32
Q

What classifies hematuria

A

> 3 RBCs per high power field on at least two occasions

33
Q

What does 1-2 g/24hr of protein found in urine indicate

A

underlying kidney abnormlaity, typically glomerular

34
Q

If >3.5 g/24hr of protein is found in the urine what does that tell you

A

nephrotic syndrome

35
Q

Why does anemia occur in CKD

A

secondary to decreased EPO

36
Q

When should EPO stimulating agents to provided in CKD

A

if Hgb falls below 10

37
Q

Why does metabolic acidosis occur in CKD

A

secondary to decreased bicarb reabsorption and generation by kidneys

38
Q

When do you treat metabolic acidosis in CKD

A

give bicarb supplementation when bicarb falls below 18

39
Q

Why does vitamin D deficiency occur in CKD

A

secondary to decreased production of 1,25-OH vitamin D b/c kidney is responsible for hydroxylation of active form

40
Q

Why does bone disease occure in CKD

A

secondary to abnomrlaities in the complex interaction between vitamin D, phosphorus, calcium and PTH

41
Q

What are risk factors for developing CKD

A
  • hypertension
  • DM
  • autoimmune disease
  • advanced age
  • previous episode of AKI
  • structural abnormalities of urinary tract
42
Q

At what stage CKD should your patient be seen by a nephrologist

A

stage 4 and 5

43
Q

What complications come along with stage 4 CKD

A
  • difficult to control HTN
  • difficult to control edema
  • hyperkalemia
  • uremia
44
Q

What do most stage 5 CKD pateitns die from

A

cardiovascular disease (MI and CVA)

45
Q

What patients reach stage 5 CKD what do they need

A

kidney transplant or they die

46
Q

What are the most common causes of end stage renal disease

A
  • diabetic glomerular disease

- hypertensive nephropathy

47
Q

What is the target A1c to prevent the progression of CKD

A

<7

48
Q

How does DM cause kidney injury

A

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
Q

What is the blood pressure goal for patients with diabetes? What does blood pressure control do?

A

<130/80, it delays the onset of microalbuminuria

50
Q

What is the first sign of diabetic nephropathy

A

microalbuminuria

51
Q

Treatment for diabetic nephropathy

A

ACE/ARB and diuretic (blood pressure control)

52
Q

Treatment of HTN

A
  • 2 to 4 gram salt restriction
  • weight loss
  • rxn
53
Q

Who does hypertensive nephropathy develop in

A

pts with proteinuria and hypertension

54
Q

How are ACE/ARBs renal protective

A

reduce glomerular permeability to proteins–> limits proteinuria and decrease glomerular intra capillary pressure

55
Q

When do you refer patients to nephrologist

A
  • GFR <30
  • rapidly progressive CKD
  • poorly controlled HTN
  • rare or genetic causes of CKD
  • suspected renal artery stenosis
56
Q

How does hemodialysis work

A

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
Q

What types of access points are used for dialysis

A
  • AV fistula

- dialysis catheter

58
Q

What is peritoneal dialysis

A

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
Q

What is the indication for a kidney transplant

A

end stage renal disease regardless of the primary cause (GFR <15)

60
Q

Where does the healthy kidney get placed when being transplanted

A

in the lower abdomen

61
Q

When is a kidney-pancreas transplant indicated

A

a patient that has kidney failure related to type 1 diabetes

62
Q

Are pateitns with type 2 diabetes eligible for a kidney-pancreas transplant? Why or why not?

A

No because the pancreas makes insulin the body is just resistant to it

clin med iii exam ii (11 decks)

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