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nefrologia > Chronic renal injury > Flashcards

Chronic renal injury Flashcards

1
Q

Chronic Renal Failure

A

Chronic renal failure

Definition: permanent reduction and progressive renal function

Irreversible damage of
renal parenchyma —–>>>

which leads to:

  • Reduction of the glomerular filtrate
  • Alteration of tubular functions
  • Deficit of endocrine and metabolic functions.
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2
Q

Chronic renal failure etiology 1

A

Glomerular nephropathies

  • primary glomerulonefritis
  • Glomerulonefriti secondary
  • Nefropatia Diabetic

tubular-interstitial nephropathies:

  • da-infectious causes (pyelonephritis, TBC)
  • da causes toxic (drugs, metals, etc)
  • da chronic obstruction of the urinary tract (Prostatic hypertrophy, calculi renal malformations, etc)
  • Nefropatia gout
  • Nefro calcinosi
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3
Q

chronic renal failure etiology 2

A

Vascular nephropathies

  • Nefroangiosclerosi
  • ipertensione blood malignant
  • vasculiti
  • necrosi bilateral cortical

Hereditary nephropathy

  • Malattia polycystic adult / child
  • Malattia medullary cystic-Nephronophthisis
  • Ossalosi; Cystinosis
  • Glomerulopatie hereditary (Syndrome Alport, nephrotic syndrome type Finnish, etc)
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4
Q

Main factors of progression of chronic kidney disease

A

FACTORS progression of chronic kidney disease

Main:
Hypertension
Proteinuria

Secondary:

  • black race
  • male
  • advanced age
  • dyslipidemia
  • Recurrent UTI
  • chronic therapy with NSAIDs
  • AVP, PDGF, TGF
  • , AII, ET-1
  • Nitric Oxide
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5
Q

Chronic Renal Failure
Clinical manifestations groups

A

Clinical manifestation groups:

  • Fluid and electrolyte abnormalities
  • Alterations neuromuscular
  • Endocrine and metabolic
  • Gastrointestinal disorders
  • Cardiovascular disorders
  • Pulmonary changes
  • Haematological disorders and immunological
  • Ocular complications
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6
Q

Clinical manifestations of CRF

Fluid and electrolyte abnormalities

A

Clinical manifestations
Fluid and electrolyte abnormalities
espansione VEC
Iperpotassiemia
acidosi metabolic
iperfosfatemia
ipocalcemia

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7
Q

Clinical manifestations of chronic renal failure

Endocrine and metabolic

A

Endocrine and metabolic
iperparatiroidismo secondary
osteodistrofia renal
intolleranza glucose
iperuricemia
dislipidemia
malnutrizione protein-calorie
infertilità and sexual dysfunction

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8
Q

Clinical manifesttations of Chronic renal failure

neuromuscular alterations.

A

Alterations neuromuscular
astenia
disturbi sleep
neuropatia device
irritabilità muscle
miopatie

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9
Q

Chronic renal failure clinical manifestations

Gastrointestinal disorders

A

Gastrointestinal disorders

nausea and vomiting
anorexia
alterazioni alvus
gastroenterite uremic
ulcera peptic

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10
Q

Chronic renal failure. clinical manifestations. cardiovascular disorders

A

Cardiovascular disorders
Ipertensione arterial
Scompenso heart failure
edema acute pulmonary
pericardite
miocardiopatia uremic
aterosclerosi accelerated

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11
Q

Chronic renal failure disorders. pulmonary and dermatological changes

A

Pulmonary changes
broncopolmoniti / pneumonia
Dermatological
iperpigmentazione (gray / ashen)
prurito
ecchimosi
uremidi (uremic frost)

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12
Q

Chronic renal failure clinical manifestations. haematological disorders and immunological

A

Haematological disorders and
immunological
anemia normochromic normocytic
linfocitopenia


bleeding tendency


susceptibility to infection

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13
Q

Chronic renal failure clinical manifestations. ocular complications and psychological changes

A

Ocular complications
Sindrome “red-eye”
Keratopatia bands
retinopatia hypertensive
Psychological changes
(Rare)
disturbi psychotic (delirium, etc)
sintomi manic
depressione

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14
Q

Chronic Renal Failure

HYPERPARATHYROIDISM SECONDARY

A
  • decrease of nephrons
  • decrease of GFR
  • decrease of kalcitriol synthesis
  • hipocalcemia
  • hipophosphatemia
  • calcificatione metastatische
  • problems with bones
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15
Q

Chronic Renal Failure
diagnosis steps

A

anamnesis
objective examination
laboratory tests
instrumental tests

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16
Q

Chronic renal failure anamnesis, questions to ask the patient

A

Chronic renal failure anamnesis

questions to ask the patient
 micturition disorders? (Burning, frequent urination and poor, etc)
 emission of dark urine? (Color Coca-Cola, to “washing of meat”)
 episodes of renal colic?
 nocturia?
 high blood pressure?
 analgesic abuse?
 other patients with kidney disease in the family?

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17
Q

Chronic renal failure diagnosis, objective examination steps and first step

A

Examination General Inspection

Skin color (ashen gray; yellowish; cyanosis)
Look for any bruising, purpuric spots
(Vasculitis); rash (erythema lupus); injuries
scratching (itch); ulcerations (diabetes mellitus,
calciphylaxis, venous insufficiency)
 edema (periorbital; parts slopes; anasarca)
 Research and evaluation of peripheral pulses
 BP Reading supine and standing positions (3 measurements)
 HR in supine and standing positions
 Assessment of body weight

annd chest and abdominal examination

18
Q

Chronic renal failure diagnosis. second step of objective examination. chest examination and abdominal examination

A

Chest examination and abdominal
 search of wet lung sounds (rales, crackles)
 Search chafing pleural / pericardial
 search of possible renal masses (polycystic kidney disease)
 rating of any globe bladder

19
Q

Chronic renal insufficiency

diagnosis, blood tests

A

Diagnosis

Blood tests

Diagnostic evaluation of:
Glomerular Filtrazione

• Azotemia /BUN increased
• Creatininemia increased
Clearance Creatinina Calcolata decreased

Anemia (ClCr < 70 ml/min)

  • G.R. decreased
  • Hb e Htc decreased
  • reticolociti decreased (%)
  • MCV, MCH, MCHC nella norma
20
Q

DEFINITION OF THE SECOND CKD
GUIDELINES according to NFK / DOQI

A

The Chronic renal injury is defined by the presence of
at least 3 months of kidney damage
characterized by:

• structural or functional abnormalities of the
kidney with or without reduction in GFR
or
• by GFR <60 mL / min also
in the absence of renal damage.

21
Q

CLASSIFICATION OF THE SECOND CKD
GUIDELINES NFK / DOQI

A

Stage

I -
GFR normal * >90

II - slight reduction
60-89

III - moderate reduction
30-59

IV - severe reduction
15-29

V - EGFR
<15

22
Q

Chronic renal failure diagnosis

Blood tests (2)

A
  • serum sodium
  • serum calcium
  • serum potassium
  • phosphorus
  • phosphatase
  • glucose
  • triglycerides
  • total cholesterol
  • uricemia
  • also might be metabolic acidosis
23
Q

Chronic renal failure diagnosis

urine examination

24 hour urine and review of

A

• Volume (1.5-2 L / day)
• creatininuria
• Electrolytes (Na
and K)
• azoturia
• Proteinuria
review of:
• Measured Creatinine Clearance ()
Intake g NaCl / day

Intake Protein g / da

24
Q

Chronic renal failure diagnosis. urine 2. morning urine

A

morning urine
Color (pale, “like water”)
• Specific Gravity  1010 (Isosthenuria)
• pH
• Examination of the sediment
• FEN> 1%

25
Q

Chronic renal failure diagnosis. renal ultrasonography.

A

Reduced dimention kidney ( Ø longitudinal and transverse)
reduction the thickness parenchymal and poor cortico-medullary differentiation.
Other possible findings: 

  • parenchymal echogenicity
  • cysts
  • cholelithiasis nuclei
  • dilatation of the urinary tract, etc

* Exceptions: polycystic kidney disease, amyloidosis, diabetes mellitus

26
Q

Chronic renal failure diagnosis. renal scintygraphy.

A

Sequential renal scintigraphy with [ 99 mTc] DTPA

Reni small with uneven uptake. The
renogram highlights transit delay and excretion of
radiotracer.

27
Q

Chronic renal failure diagnosis. other imaging studies.

A
  • Fund eyepiece
  • Holter (24 h)
  • ECG
  • Echocardiography
  • Ultrasound abdomen and pelvis
  • Eco-doppler TSA
  • Eco-doppler renal artery
  • chest X-ray
  • Rx skeletal
  •  MOC
  •  Direct abdomen
  •  Other (urography, CT scan, etc)
28
Q

Chronic renal insufficienecy vs acute renal insufficiency

A

In chronic renal insufficiency and not in acute RI there is:

  • Hypertension long life
  • Anemia normochromic and normocytic
  • Hypocalcemia and hyperphosphatemia
  • Nocturia
  • reduced kidney size in ultrasound
29
Q

Chronic renal failure therapy. conservative therapy vs replacement therapy

A

 CONSERVATIVE THERAPY
Dietetics
Pharmacological

 REPLACEMENT THERAPY
Hemodialysis
Peritoneal Dialysis
Transplant

30
Q

Chronic renal failure

therapy objectives

A

 Prevent and treat the clinical manifestations
 Slowing the progression
 Ensure a good nutritional status

31
Q

Chronic renal failure conservative therapy

A

Diet

Dietary therapy is essentially based
on reducing NaCl and
(Low value proteins of plant origin
organic, that is poor in essential amino acids),
and on the administration of an adequate share of calories

32
Q

Conservative therapy for chronic renal failure. diet

A

CONSERVATIVE THERAPY

  • *Reduced supply of protein**
  • ->
  • reduced nitrogen
  • reduced conc. of phosphorus
  • reduce of acidity
  • reduced rate of progression
    Adequate caloric intake
    (30-35 kcal / kg / day)
    Prevents catabolism
    of endogenous proteins
    for energy purposes
33
Q

Sodium CRF conservative therapy

A

Sodium

SODIUM (if not nephropathy with salt loss)

Reduce to 5-6 g / day the amount of salt

supplied by food.

34
Q

CRF conservative therapy intake of liquids, potassium

A

INTAKE OF
LIQUIDS- normal

Reduce the daily intake of fruit
fresh / dried fruit juices, vegetables …

Avoid using salt substitutes
kitchen

Assume per os, possibly, resins
trade off Cation (Kayexalate)

35
Q

CRF conservative therapy. calcium.

A

Integrating dietary intake with 1-1.5
g / day of Calcium Carbonate, recruited
fasting.

Administered orally, possibly,
0.25-0.50 microg / day of calcitriol

36
Q

CRF conservative therapy. phosphorus, bicarbonate

A

phosphorus
Contain dietary intake at 400-
600 mg / day (low protein diet)

BICARBONATE
Useful oral dosing of 2-5 g / day

37
Q

Chronic Renal Failure. Drug therapy.

A

First choice drugs:
 ACE inhibitors or ARBs
(Anti-hypertensive, anti-proteinuric and
slowing the progression of the disease
kidney)
 Loop diuretics
(Correction hypervolemia)
Second choice drugs:

 Calcium channel blockers

 beta-blockers

 Peripheral vasodilators
 centraal alfa2-agonists

38
Q

Chronic renal failure. Drug therapy.2

A

Glycemic control

  • *Gly <= 110-120 mg / d**
  • *HbA1c < 7%**

sulphonylureas, Insulin

sulphonylureas, Insulin,

Lipid control

LDL-cholesterol <= 100 mg / dl
statins

anemia control

Statins
recombinant human erythropoietin
Darbopoietina
 Iron gluconate, sulfate, etc
 Folic Acid
 Vitamin B12

39
Q

Chronic renal failure replacement therapy. absolute Indications for the start of dialysis

A

REPLACEMENT THERAPY

INDICATIONS FOR THE START OF dialysis

Absolute

  • pericarditis
  • Fluid overload and pulmonary edema not responsive to diuretics
  • Hypertension unresponsive to medication
  • Hyperkalemia not responsive to drug treatment
  • Motor neuropathy and encephalopathy
  • Bleeding diathesis
  • Persistent nausea and vomiting
  • Malnutrition
40
Q

Chronic renal failure, replacement therapy.

Relative indications for the start of dialysis

A
  • Creatinine clearance <10-15 ml / min
  • Azotemia with anorexia, nausea and vomiting morning
  • Tiredness and fatigue
  • Anemia resistant al’eritropoietina
  • Persistent itching and severe

nefrologia (6 decks)

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