CKD Flashcards
3 important endocrine functions of the kidneys
Produces erythropoietin- stimulates RBC production
Activates Vitamin D
Produces renin, which helps regulate blood pressure
Normal BUN Values
10 - 20 mg/dL
Normal Creatinine Values
0.5 - 1.2 mg/d
Normal GFR
> 90 mL/min
T/F BUN & Creatinine maintain a 10:1 ratio
True
What is Chronic Kidney Disease(CKD)
Presence of kidney damage for more than 3 months with or without a GFR of < 60
CKD has an inability to
Maintain acid-base balance
Remove end products of metabolism
Maintain fluid and electrolyte balance
5 Stages of CKD
1
Kidney damage with normal or increased GFR
≥ 90
2
Kidney damage with mild decrease in GFR
60-89
3
Moderate decrease in GFR
30-59
4
Severe decrease in GFR
15-29
5
End stage kidney [renal] disease (ESRD)
<15
Causes of ESKD
Diabetes, 50%
HTN, 30%
Glomerulo-nephritis, 10%
Other, 10%
9 Risk factors for CKD
Family history and other vascular problems Increasing age (>60) Male African American HTN, DM, smoking Overweight and obesity
3 key characteristics of PATHO of CKD
Glomerulosclerosis – scar tissue in glomerulus, tissue can not filter blood properly
Interstitial fibrosis – destruction of renal tubules and interstitial capillaries
Interstitial inflammation – further damage
What plays a major role in the process of CKD
Complement – inflammatory processes
Angiotensin II – increase in BP
Clinical Manifestations of CKD by stage
1
Asymptomatic
2
Asymptomatic, possible HTN
3
HTN, otherwise asymptomatic
4
Manifestations becoming apparent– diagnosis often occurs here
5- ESRD
“Uremia” – Retention of many metabolic wastes
what is uremia
Retention of many metabolic wastes
Urea Creatinine Phenols Hormones Electrolytes Water
Often seen when GFR ≤ 10 mL/min
psychologic manifestations of ESRD
Anxiety
Depression
cardio manifestations of esrd
HTN heat failure coronary artery disease pericarditis peripheral artery disease
gasto manifestations of esrd
N/V
anorexia
gastro bleeding
gastritis
neruo manifestations of esrd
fatigue
H/A
sleep disturbance
encephalopathy
ocular manifestation of esrd
HTN retinopathy
pulmonary manifestations of esrd
pulmonary edema
uremic pleuritis
pneumonia
endocrine/reproductive manifestations of esrd
hyperparathyroidism
thyroid abnormalities
amenorrhea
ED
metabolic issues with esrd
card intolerance
hyperlipidemia
hematologic issues with esrd
anemia
bleeding
infection
integumentary issues with esrd
pruitus
ecchymosis
dry
scaly skin
peripheral neuro issues with esrd
paresthesias
restless legs
musculoskeletal issues with esrd
vascular and soft tissue calcification
osteomalcia
ostelitis fiborsa
4 issues with abnormal kidney function and resulting clinical manifestation
No longer maintains F & E homeostasis ——
Edema, hyperkalemia, hyperphosphatemia, hypermagnesemia, metabolic acidosis
No longer rids the body of wastes via urine ——–
Anorexia, malnutrition, itching, CNS changes
Decreased production of erythropoietin ——–
Anemia
Decreased activation of Vitamin D———-
Renal osteodystrophy
what are CKD drugs used for
slow the rate of progression of CKD-----Reduce BP to less than 140/90 Treat hyperlipidemia (cholesterol less than 200)
Treat the complications of CKD---------------Hyperkalemia Metabolic acidosis Hyperphosphatemia Renal osteodystrophy Anemia
what drugs slow the progression of CKD by controlling BP
ACE or ARB
Other BP meds as needed to maintain SBP (110-130) 140
what drugs slow the progression of CKD by controlling lipids
Statins
Tx volume overload in CKD
Loop diuretic
Used with a low-salt diet
Tx of hyperkalemia in CKD
Multiple (ex. = diuretic)
Addressed with hemodialysis in ESRD
tx of metabolic acidosis in CKD
sodium bicarb
an alkaline agent
tx of hyperphos with ckd
calcium carb
a phosphate binder
tx of renal osteodystrophy with ckd
calcitriol
activated vit D
tx of anemia in ckd
erythropoietin
Black box warning DVT
Goals of therapy with sodium bicarb
Slow progression of CKD
Prevent bone loss
Improve nutritional status
administration of sodium bicarb
Initiate when plasma HCO3 is < 15 mEq/mL
What lab test do we use to measure this? CO2 on BMP
Titrate to a HCO3 of 18-20
Consider switch to sodium citrate if bloating is a problem
moa of calcium carb
bind to phosphate
goals of calcium carb
keep phos levels normal
reduce mortality
what is important with calcium carb
take with meals and watch for hypercalcium
moa of calcitriol
Activated form of Vitamin D
Stimulates intestinal absorption of calcium/phosphate and bone mineralization
adverse effects of calcitriol
Hypercalcemia
Hyperphosphatemia
what are signs of calcium toxicity
GI upset,
bone pain,
neuro effects,
cardiac arrhythmias
Drugs of concern with complications
Digoxin
Diabetic agents (glyburide, metformin)
Antibiotics (Vancomycin)
Opioids (morphine)
