Chronic renal failure Lecture Flashcards

1
Q

Spectrum of disease with declining function/Decreased glomerular filtration rate
Resultant increase in nitrogenous waste products (azotemia)
Alteration in fluid an electrolytes

A

CKD

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2
Q

Currently is based on 3mo of disease and

eGFR of

A

CKD

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3
Q

2 most common causes today of CKD

A

diabetes

hypertension (nephrosclerosis)

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4
Q
Anorexia (Loss of appetite, Resultant weight loss)
Nausea or vomiting
Malaise
Headache
Itching
A

CKD symptoms

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5
Q

Decrease in Na+ transport which is a large source of energy/heat production leads to…..

A

Hyperthermia (seen in CKD)

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6
Q

“Pseudodiabetes”

Slower handling of glucose load due to insulin resistance

A

Impaired carb metabolism (in CKD)

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7
Q

what happens to triglyceride levels in CKD?

A

Increase

but normal cholesterol

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8
Q

potassium does what in CKD?

A

increases

sodium goes down

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9
Q

Decreased K+ excretion, typically if GFR

A

Seen in CKD

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10
Q

When GFR decreases below 10cc/min, ___ increases as aldosterone affect is blunted

A

K+

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11
Q

aldosterone antagonist that…
Promotes diuresis
K+ retention
Used to treat HTN and CHF

A

Spironolactone

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12
Q

Acidosis causes efflux of K+ from intracellular to extra cellular fluids
ACE inhibitors, Beta-blockers, Cyclosporine in transplant all can lead to as well
May lead to cardiac arrhythmias and even death

A

Impacts of Hyperkalemia

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13
Q
Sodium bicarbonate
Loop diuretic
Insulin
Dextrose
Fluids (dilutes the K+)
Albuterol
Sodium polystyrene-Ion exchange resin (PO or PR)-Kaexalate®
Dialysis
A

Hyperkalemia tx

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14
Q

Hyperuricemia (increase gout)

A

Seen in renal failure

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15
Q

Which acid-base disorder is commonly seen in kidney disease?

A

Metabolic acidosis

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16
Q

calcium leeches out of bones, increasing risk fracture

A

seen in renal failure

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17
Q

Osteomalacia and osteitis fibrosa cystica (due to hyperparathyroidism) both increase….

A

Risk fracture

18
Q

Decreased conversion of Vitamin D to 1,25 dihydroxyvitamin D
Decrease in serum calcium
Increased parathyroid hormone (PTH) secretion

Results in…

A

weaker bones

19
Q

Decreased phosphorus excretion (decreased filtration in renal failure)
Increased secretion of PTH

Results in…

A

further bone deterioration

20
Q

Restrict diet (limit proteins, avoid dairy, limit colas)
Calcium carbonate or calcium acetate (bind phosphate)
Possibly aluminum (Binds Phosphate, may cause osteomalacia)
Sevelamer (RenaGel)

A

Hyperphosphatemia treatment

21
Q

if calcium phosphorus product is above 70, you can get…

A

calcification of solid organs

22
Q

Most common complication of end stage renal disease

A

HTN

*most commonly due to fluid overload

23
Q

HTN
Pericarditis
Anemia

A

all seen in renal dz

24
Q

if hematocrit is under 30, use…

A

Erythropoietin

25
Q

Na+ or water restriction
Phosphate restriction-dietician
Protein restriction-dietician
Blood pressure control (

A

Chronic renal failure tx

26
Q

Cancer, severe CAD, CVA are contraindications for..

A

Dialysis

27
Q

hemodialysis requires a…

A

shunt

28
Q

peritoneal dialysis requires a…

A

catheter

29
Q

Diffusion across semipermeable membrane
Uses variable concentrations of solute (dialysate)
300-450 cc/min of blood flow required
9-12 hours per week
If using negative pressure on dialysate side=ultrafiltration

A

Hemodialysis

30
Q
  • Anemia
  • Catheter related (Poor flow rates, Plugged grafts, Infection, Aneurysm)
  • Disequilibrium
  • Arrhythmia
  • Hypotension
  • Infection (Hep B must be separated, CMV, Hep C)
  • Requires heparin (bleeding, thrombocytopenia)
A

Hemodialysis complications

31
Q

Most common cause of death in hemodialysis patients

A

Heart disease

32
Q

Intermittent (old)
Continuous
Cyclic (nighttime)
Now use longer dwell times, up to 4-6 hours
2 litre volumes (caution pulmonary disease)
Uses osmotic agent of dextrose

A

Peritoneal dialysis

33
Q

No heparin
Independence
No vascular access

A

advantages of peritoneal dialysis

34
Q
Longer treatment times
Can’t use if adhesions or lung disease
Peritonitis average 2 infections per year
Catheter tunnel infections
Malnutrition
A

disadvantages of peritoneal dialysis

35
Q

Most effective means to treat chronic renal failure

A

transport

well being and cost effective

36
Q

Due to nephrosclerosis

Renal ischemia, HTN, and fibrosis all contribute to…..

A

Renal transplant rejection

37
Q

3 different proteinuria types

A

glomerular
tubular
overflow

38
Q

Greater than 3500mg/d with:
Hypoalbuminemia (urine loss and decreased synthesis)
Edema (Decreased osmotic pressure)
Hyperlipidemia (Decreased protein stimulates synthesis)
Also can get hypercoagulability

A

Nephrotic syndrome

39
Q
Treat hypertension
ACE inhibitors
ARBS
Protein restriction
Treat edema (loop diuretics)
Treat cholesterol (?statin)
?Anticoagulants
A

Proteinuria treatment

40
Q

nephrOtic…

A

prOtein

41
Q

nephritic…

A

cells