Chronic renal failure Lecture Flashcards
Spectrum of disease with declining function/Decreased glomerular filtration rate
Resultant increase in nitrogenous waste products (azotemia)
Alteration in fluid an electrolytes
CKD
Currently is based on 3mo of disease and
eGFR of
CKD
2 most common causes today of CKD
diabetes
hypertension (nephrosclerosis)
Anorexia (Loss of appetite, Resultant weight loss) Nausea or vomiting Malaise Headache Itching
CKD symptoms
Decrease in Na+ transport which is a large source of energy/heat production leads to…..
Hyperthermia (seen in CKD)
“Pseudodiabetes”
Slower handling of glucose load due to insulin resistance
Impaired carb metabolism (in CKD)
what happens to triglyceride levels in CKD?
Increase
but normal cholesterol
potassium does what in CKD?
increases
sodium goes down
Decreased K+ excretion, typically if GFR
Seen in CKD
When GFR decreases below 10cc/min, ___ increases as aldosterone affect is blunted
K+
aldosterone antagonist that…
Promotes diuresis
K+ retention
Used to treat HTN and CHF
Spironolactone
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
Impacts of Hyperkalemia
Sodium bicarbonate Loop diuretic Insulin Dextrose Fluids (dilutes the K+) Albuterol Sodium polystyrene-Ion exchange resin (PO or PR)-Kaexalate® Dialysis
Hyperkalemia tx
Hyperuricemia (increase gout)
Seen in renal failure
Which acid-base disorder is commonly seen in kidney disease?
Metabolic acidosis
calcium leeches out of bones, increasing risk fracture
seen in renal failure
Osteomalacia and osteitis fibrosa cystica (due to hyperparathyroidism) both increase….
Risk fracture
Decreased conversion of Vitamin D to 1,25 dihydroxyvitamin D
Decrease in serum calcium
Increased parathyroid hormone (PTH) secretion
Results in…
weaker bones
Decreased phosphorus excretion (decreased filtration in renal failure)
Increased secretion of PTH
Results in…
further bone deterioration
Restrict diet (limit proteins, avoid dairy, limit colas)
Calcium carbonate or calcium acetate (bind phosphate)
Possibly aluminum (Binds Phosphate, may cause osteomalacia)
Sevelamer (RenaGel)
Hyperphosphatemia treatment
if calcium phosphorus product is above 70, you can get…
calcification of solid organs
Most common complication of end stage renal disease
HTN
*most commonly due to fluid overload
HTN
Pericarditis
Anemia
all seen in renal dz
if hematocrit is under 30, use…
Erythropoietin
Na+ or water restriction
Phosphate restriction-dietician
Protein restriction-dietician
Blood pressure control (
Chronic renal failure tx
Cancer, severe CAD, CVA are contraindications for..
Dialysis
hemodialysis requires a…
shunt
peritoneal dialysis requires a…
catheter
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
Hemodialysis
- 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)
Hemodialysis complications
Most common cause of death in hemodialysis patients
Heart disease
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
Peritoneal dialysis
No heparin
Independence
No vascular access
advantages of peritoneal dialysis
Longer treatment times Can’t use if adhesions or lung disease Peritonitis average 2 infections per year Catheter tunnel infections Malnutrition
disadvantages of peritoneal dialysis
Most effective means to treat chronic renal failure
transport
well being and cost effective
Due to nephrosclerosis
Renal ischemia, HTN, and fibrosis all contribute to…..
Renal transplant rejection
3 different proteinuria types
glomerular
tubular
overflow
Greater than 3500mg/d with:
Hypoalbuminemia (urine loss and decreased synthesis)
Edema (Decreased osmotic pressure)
Hyperlipidemia (Decreased protein stimulates synthesis)
Also can get hypercoagulability
Nephrotic syndrome
Treat hypertension ACE inhibitors ARBS Protein restriction Treat edema (loop diuretics) Treat cholesterol (?statin) ?Anticoagulants
Proteinuria treatment
nephrOtic…
prOtein
nephritic…
cells
