Chronic Renal Failure - AO

Question 1

What are the endocrine functions of the kidney?

Answer 1

Release of calcitriol, erythropoietin, renin.

Question 2

What is the definition of chronic renal failure?

Answer 2

Decline in function of the kidney characterized by at least 3 months of reduced GFR

Question 3

What is the most common etiology in the US associated with the development of chronic renal failure?

Answer 3

Diabetes

Question 4

What is the diagnosis and staging of CRF based on?

Answer 4

1) GFR

2) Albuminuria (> 30 mg/g)

Question 5

At what stage of CRF do symptoms begin to appear?

Answer 5

Stages G4 - G5 (anemia, fatigue, acidosis, electrolyte abnormalities, uremia)

Question 6

What other organ systems are involved in CRF and how are they affected?

Answer 6

1) Hematological: anemia (↓ EPO)
2) Cardiovascular: LVH (Heart failure)
3) Musculoskeletal: ↑ PTH → weakened bones
4) Neurologic: uremia
5) Skin: edema
6) Nervous system: depression, sleep problems
7) Basically everything

Question 7

How would you control blood pressure in a patient with CRF?

Answer 7

• Typically 3 or 4 meds plus one ACEI or ARB

- Diuretic, aldosterone receptor antagonists to reduce stress on cardiovascular system

Question 8

How would you manage decreased insulin clearance in a patient with CRF?

Answer 8

-↓ diabetes medications to prevent hypoglycemia

Question 9

How would you manage anemia in a patient with CRF?

Answer 9

• Hemoglobin every 4-6 months
• Iron supplements
• Consider EPO stimulating agent

Question 10

What dietary restrictions/medications would be placed on a patient with CRF to control electrolyte imbalances?

Answer 10

• Low salt diet + diuretic therapy
• Low protein diet + renin inhibitor (tekturna)
• Low lipid diet (goal is LDL < 100)
• Maintain potassium
• Reduce phosphate via calcium carbonate
• -vitamin D/calcium supplements
• Sodium bicarbonate for metabolic acidosis

Question 11

When should referral to a transplant center be made (what GFR value)?

Answer 11

GFR < 20 mL/minute