CKD 1 Flashcards
people more likely to be affected by CKD
AA
Males
> 65
stage 1
renal damage with normal/increased GFR
> 90 GFR
stage 2
renal damage, decreased GFR
60-89
stage 3
A: 45-59
B: 30-44
moderately reduced GFR
stage 4
severely reduced GFR
15-29
stage 5
end stage renal failure
<15, dialysis
two main causes of CKD
HTN
DM
other causes of CKD (7)
- PCKD
- Glomerular Disease
- Tubule intersitital disease
- Vascular disease (emboli, RAS, vasculitides)
- infection (hepatitis, HIV, syphilis)
- drugs (heroin, contrast, anti-rejection)
- GU tract obstruction
renal biopsy
tells us definitive cause but is only preformed when etiology is unclear
CKD and CVD
independent risk factor of CVD
s/s of CKD
typically asymptomatic until stage 4 or 5
generalized (chronic illness - weakness, malaise)
GI (hiccups, anorexia)
skin changes
neuro (cognitive defects, clonus)
CV (fluid overload s/s)
natural history of CKD
nephrons start to die, remaining nephrons increase filtration and excretion rates
increased oxygen species produced by overworked nephrons, causing more death
fewer nephrons available and glomerular capillaries rise, causing sclerosis
kidney is unable to control acidosis and hyperkalemia
can’t excrete enough water and fluid overload occurs
severe CK causes
decreased bicarbonate
unable to excrete organic acids
unable to excrete potassium
CKD pts are vulnerable to
fluid overload (LE, 3rd space, pleural effusions)
edema
hyperkalemia
hyponatremia (dilutional)
goals of conservative CKD management (4)
- slow progression
- identify and correct reversible causes
- identification and tx of complications
- preparing patient for dialysis or transplant
slowing progression - diet
restriction of Na+, K+, PO4- via diet and medications
consider protein restriction (0.6-0.75 g/kg/day) but renal failure is catabolic
aggressive management of DM
slowing CKD progression HTN
management of BP 130/80 or less
req. 2-3 anti-HTN drugs
medications for HTN that are nephroportecitve
ACE
ARB
CCB
reversible causes of worsening CKD
- decreased renal perfusion
- obstruction or infection
- nephrotoxins
when are patients referred to nephrologist
as GFR approaches 40
still in stage IIIB (30-44)
stages 1-3B CKD treatment
medications and DM control
nephroprotective meds
progression to stage IV CKD referrals
vascular surgeon for AV graft placement
nephrologist for CKD complications and HTN, lab abnormalities
lab abnormalities in CKD
CR issues
BUN
phosphorus
choices for renal replacement therapy
- hemodialysis
- PD
- kidney transplant
criteria for initiating dialysis
GFR 10-15 mL/min
OR
higher GFR w/symptoms of ESRD
MC cause of mortality
overall + sudden
overall mortality: CVD
sudden: hyperkalemia (non compliance w/diet or dialysis)
hemodialysis indicated in patients w.reccurent
- metabolic acidosis, pH < 7.1
- volume overload resistant to diuresis
- encephalopathy
- pericarditis
- persistent hyperkalmia (>6.5)
- intractable and severe GI symptoms
access options for HD
- temporary central venous cath
- AV graft
- AV fistula
central venous HD cath
double lumen cath tunneled under skin before entering major vein
complication: infection, only suitable for short term use
AV grafts
made of PTFE and connect artery and vein, blood is pulled from a., cleaned then put in other side
benefits: cannulated for HD w/in weeks of placement, quicker than fistulas
drawbacks: high failure rate than fistulas, thrombosis, infection, steal, aneurysm
AV fistulas
use native veins as conduit for AV connection
benefits: lowest rate of infection, least costly, associated with decreased M and M
drawbacks: must mature, high rate of primary failure, aneurysms, bleeding steal
hemodialysis (definition + frequency + SE)
blood pump thru dialysis machine and toxins diffuse into a solution
4hrs, 3x/week
SE: pos leave exhausted -malaise, weakness, n/v
muscle cramping, heart work load
process of HD
blood is circulated thru synthetic membrane, kept warm and returned to patient
diasylate enters in flow opposite of blood
wastes diffuse down concentration gradient to remove
cleanest diaslyate with cleanest blood
advantages of in center hemodialysis
nurses provide tx for patient
no equipment needed for supplies
medical help available quickly in emergency
disadvantages of in center hemodialysis
come to dialysis center 3 times a week
two needle sticks for ea. treatment
restrict diet and fluid intake
home HD advantage
no travel
trained caregiver helps
more control over treatments and schedule
home HD disadvantage
training of patient and caregivers for 4-6 weeks
must have trained caregiver, room to store supplies
req. two needle sticks
two types of peritoneal dialysis
- continuous CAPD (exchanged 4-6x/day)
2. CCPD (done by machine over night)
advantages of PD
flexible lifestyle, independence
clinic visits monthly
no needles involved
most natural
disadvantages of PD
must adapt daily routine
req. permanent catheter in abdomen
storage space
cause painting to gain weight
cannot be done indefinitely
renal transplant
can be done from living or cadaver donors
ABO group compatible patient
referred for consideration of transplant at 30 GFR, considered once <20
patients are immunosuppressed and have higher risk of developing malignancy
contraindications to renal transplant
active infection
active malignancy
chronic illness w/short life expectancy
active substance abuse
advantages of transplant
closest to having own kidney
no dialysis req.
feel healthier and better
disadvantages of renal transplant
stress related to waiting
risks associated with major surgery
anti rejection meds req.
