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FA17 Nephrology > CKD 1 > Flashcards

CKD 1 Flashcards

1
Q

people more likely to be affected by CKD

A

AA

Males

> 65

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2
Q

stage 1

A

renal damage with normal/increased GFR

> 90 GFR

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3
Q

stage 2

A

renal damage, decreased GFR

60-89

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4
Q

stage 3

A

A: 45-59
B: 30-44

moderately reduced GFR

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5
Q

stage 4

A

severely reduced GFR

15-29

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6
Q

stage 5

A

end stage renal failure

<15, dialysis

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7
Q

two main causes of CKD

A

HTN

DM

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8
Q

other causes of CKD (7)

A
  1. PCKD
  2. Glomerular Disease
  3. Tubule intersitital disease
  4. Vascular disease (emboli, RAS, vasculitides)
  5. infection (hepatitis, HIV, syphilis)
  6. drugs (heroin, contrast, anti-rejection)
  7. GU tract obstruction
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9
Q

renal biopsy

A

tells us definitive cause but is only preformed when etiology is unclear

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10
Q

CKD and CVD

A

independent risk factor of CVD

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11
Q

s/s of CKD

A

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)

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12
Q

natural history of CKD

A

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

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13
Q

severe CK causes

A

decreased bicarbonate

unable to excrete organic acids

unable to excrete potassium

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14
Q

CKD pts are vulnerable to

A

fluid overload (LE, 3rd space, pleural effusions)

edema

hyperkalemia

hyponatremia (dilutional)

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15
Q

goals of conservative CKD management (4)

A
  1. slow progression
  2. identify and correct reversible causes
  3. identification and tx of complications
  4. preparing patient for dialysis or transplant
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16
Q

slowing progression - diet

A

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

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17
Q

slowing CKD progression HTN

A

management of BP 130/80 or less

req. 2-3 anti-HTN drugs

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18
Q

medications for HTN that are nephroportecitve

A

ACE
ARB
CCB

19
Q

reversible causes of worsening CKD

A
  1. decreased renal perfusion
  2. obstruction or infection
  3. nephrotoxins
20
Q

when are patients referred to nephrologist

A

as GFR approaches 40

still in stage IIIB (30-44)

21
Q

stages 1-3B CKD treatment

A

medications and DM control

nephroprotective meds

22
Q

progression to stage IV CKD referrals

A

vascular surgeon for AV graft placement

nephrologist for CKD complications and HTN, lab abnormalities

23
Q

lab abnormalities in CKD

A

CR issues
BUN
phosphorus

24
Q

choices for renal replacement therapy

A
  1. hemodialysis
  2. PD
  3. kidney transplant
25
Q

criteria for initiating dialysis

A

GFR 10-15 mL/min

OR

higher GFR w/symptoms of ESRD

26
Q

MC cause of mortality

overall + sudden

A

overall mortality: CVD

sudden: hyperkalemia (non compliance w/diet or dialysis)

27
Q

hemodialysis indicated in patients w.reccurent

A
  1. metabolic acidosis, pH < 7.1
  2. volume overload resistant to diuresis
  3. encephalopathy
  4. pericarditis
  5. persistent hyperkalmia (>6.5)
  6. intractable and severe GI symptoms
28
Q

access options for HD

A
  1. temporary central venous cath
  2. AV graft
  3. AV fistula
29
Q

central venous HD cath

A

double lumen cath tunneled under skin before entering major vein

complication: infection, only suitable for short term use

30
Q

AV grafts

A

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

31
Q

AV fistulas

A

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

32
Q

hemodialysis (definition + frequency + SE)

A

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

33
Q

process of HD

A

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

34
Q

advantages of in center hemodialysis

A

nurses provide tx for patient

no equipment needed for supplies

medical help available quickly in emergency

35
Q

disadvantages of in center hemodialysis

A

come to dialysis center 3 times a week

two needle sticks for ea. treatment

restrict diet and fluid intake

36
Q

home HD advantage

A

no travel

trained caregiver helps

more control over treatments and schedule

37
Q

home HD disadvantage

A

training of patient and caregivers for 4-6 weeks

must have trained caregiver, room to store supplies

req. two needle sticks

38
Q

two types of peritoneal dialysis

A
  1. continuous CAPD (exchanged 4-6x/day)

2. CCPD (done by machine over night)

39
Q

advantages of PD

A

flexible lifestyle, independence

clinic visits monthly

no needles involved

most natural

40
Q

disadvantages of PD

A

must adapt daily routine

req. permanent catheter in abdomen

storage space

cause painting to gain weight

cannot be done indefinitely

41
Q

renal transplant

A

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

42
Q

contraindications to renal transplant

A

active infection
active malignancy
chronic illness w/short life expectancy
active substance abuse

43
Q

advantages of transplant

A

closest to having own kidney

no dialysis req.

feel healthier and better

44
Q

disadvantages of renal transplant

A

stress related to waiting

risks associated with major surgery

anti rejection meds req.

FA17 Nephrology (13 decks)

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