Chronic Renal Insufficiency

Question 1

What are 8 clinical abnormalities seen with chronic renal insufficiency?

Answer 1

1. dehydration
2. metabolic acidosis
3. hypokalemia
4. uremia
5. anorexia
6. calcium/phosphorus imbalance
7. anemia
8. hypertension

Question 2

Why are patients with chronic renal insufficiency typically dehydrated? How is it treated?

Answer 2

polyuria typically occurs with CRI, which causes renal hypoperfusion and pre-renal azotemia

increase oral water consumption by providing plentiful fresh water and feeding canned food +/- saline or LRS fluid therapy

Question 3

What treatment is recommended for patients with chronic renal insufficiency and metabolic acidosis?

Answer 3

• potassium citrate = oral alkalinizer
• sodium bicarbonate reserved for patients with severe acidosis

therapy us not typically necessary

Question 4

Why do patients with chronic renal insufficiency develop uremia? What does this lead to?

Answer 4

inability to excrete metabolic byproducts leads to buildup or uremia and other uremic toxins in the bloodstream

• CNS depression
• anorexia
• nausea, vomiting, halitosis
• gastritis

Question 5

Why do patients with chronic renal insufficiency commonly become anorexic? How is this treated?

Answer 5

uremic ulcers and gastritis, dehydration, metabolic acidosis, hypokalemia

address the problems above +/- H2 blockers (Famotidine)

Question 6

How does chronic renal insufficiency cause a calcium/phosphorus imbalance? What are 3 options for treatment?

Answer 6

renal damage causes increased phosphate levels, which leads to excessive PTH secretion, renal osteodystrophy, extraskeletal mineralization, and further progression of renal dysfunction

1. limiting dietary phosphorus intake
2. phosphate binding agents - aluminum hydroxide, aluminum carbonate
3. calcitriol

Question 7

Why are patients with chronic renal insufficiency commonly anemic? What treatment can be pursued?

Answer 7

inadequate renal erythropoietin production

recombinant human erythropoietin or Varenzin-CA1

Question 8

How is hypertension associated with chronic renal insufficiency treated?

Answer 8

ACE inhibitors - Benazepril, Enalapril

Question 9

What are 5 parts to dietary therapy of chronic renal insufficiency?

Answer 9

1. low protein - minimizes uremia
2. high moisture - minimizes fluid, electrolyte, and mineral deficits
3. minimize acidosis
4. palatable, sufficient caloric density - promotes general nutrition
5. low phosphorus - slow progression of renal disease

Question 10

Other than dietary therapy, what are 6 important treatments used for patients with chronic renal insufficiency?

Answer 10

1. phosphate binders - aluminum hydroxide/carbonate
2. oral supplementation of potassium
3. ACE inhibitors for hypertension - Benazepril, Enalapril
4. H2 blockers - Famotidine
5. calcitriol - reduce PTH and improve therapeutic outcome
6. recombinant humans erythropoietin or Varenzin-CA1 –> if anemia is significant enough to compromise quality of life