CKD 1 Flashcards by Sara Fieger

people more likely to be affected by CKD

Males

> 65

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stage 1

renal damage with normal/increased GFR

> 90 GFR

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stage 2

renal damage, decreased GFR

60-89

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stage 3

A: 45-59
B: 30-44

moderately reduced GFR

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stage 4

severely reduced GFR

15-29

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stage 5

end stage renal failure

<15, dialysis

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two main causes of CKD

HTN

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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

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renal biopsy

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

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CKD and CVD

independent risk factor of CVD

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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)

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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

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severe CK causes

decreased bicarbonate

unable to excrete organic acids

unable to excrete potassium

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CKD pts are vulnerable to

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

edema

hyperkalemia

hyponatremia (dilutional)

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goals of conservative CKD management (4)

slow progression
identify and correct reversible causes
identification and tx of complications
preparing patient for dialysis or transplant

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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

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slowing CKD progression HTN

management of BP 130/80 or less

req. 2-3 anti-HTN drugs

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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

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

access options for HD

1. temporary central venous cath 2. AV graft 3. 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

1. 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.