CKD Flashcards
Primary Kidney Function
Filtration
Regulate fluid, electrolyte and acid-base balance in the body
Secretion
Secondary kidney function
Help regulate
BP
bone density
erythropoiesis (production of RBC)
Location of kidneys
below the rib cage
Renal artery/vein function
blood enters through the artery and then the vein returns the reabsorbed nutrients back into the bladder
Three main steps of urine formation
glomerular filtration, reabsorption, and secretion
Glomerular filtration
Glomerulus (part of nephrons) = site of blood filtration –> water and solutes leave the blood stream and enter the filtration system
network of capillaries that
Reabsorption
Filtrate (glomerulus) contains waste and other substances such as essential ions, glucose, amino acids and smaller proteins .
After filtration, goes to renal tubule and water and needed nutrients goes back into blood stream.
Secretion
Waste ions and hyrdogen ions pass from the capillaries into the renal tubule (create urine).
Goes from nephron tubule to the collecting duct
Out kidneys - renal pelvis - ureter - bladder
Urine
95% water
5% waste
Nitrogenous wastes in Urine
urea, creatinine, ammonia, uric acid
Ions in urine
Na, K, H, Ca
Kidney disease is irreversible and progressive (T/F)
T
CKD can be defined as…
kidney damage
GFR , 60mL/minute/1.73 m for 3 months or longer
What does the end result/progression look like?
nephrons hypertrophy to compensate
systemic disease involving every organ
Causes of ESRD
DM
Renal vascular disease
ESRD treatment
Renal replacement therapy
- Hemodialysis
- Peritoneal dialysis
Transplant
Dialysis
A technique in which substances move from the blood through a semipermeable membrane (dialyzer) and into a dialysis solution (dialysate)
Hemodialysis (HD)
Removes waste products and excess fluid from the blood using a machine which
pumps the blood through an artificial semipermeable membrane called a dialyzer or an artificial kidney
3 sessions a week at a clinic or trained at home (equipment)
Peritoneal Dialysis (PD)
Blood is cleansed within the peritoneal cavity everyday by the patient’s
themselves. A surgically inserted catheter is placed in the abdomen
People with AKI or ESRD
CAPD = no machine, 3-5 times a day APD = cycler machine at night while sleeping
Retained substances
Urea Creatinine Phenols Hormones Electrolytes Water
Uremia
Build up of toxins in the body (kidney failure) - can not filter out and secrete
Manifestations
Urinary System
Polyuria
Oliguria
Anuria
Polyuria
Excessive urination
Early stages
results from inability of kidneys to concentrate urine.
occurs most often at night (nocturia).
specific gravity fixed around 1.010.
(if they are on dialysis, are they making urine?)
Oliguria
<400mL daily of urine
shows worsening CKD
Anuria
Urine output <40mL/day
Manifestations
Metabolic
Waste product accumulation
Altered carbohydrate metabolism
Defective carbohydrate metabolism
Elevated triglycerides
Waste product accumulation
Decreased GFR, increased BUN and creatinine levels
BUN
measures urea levels in the blood (waste products)
Altered carbohydrate metabolism
caused by impaired glucose use from cellular insensitivity to the normal action of insulin
Defective carbohydrate metabolism
Insulin is dependent on kidneys for excretion
people with DM might need more insulin when uremic
Elevated triglycerides
Hyperinsulinemia stimulates hepatic production of triglycerides
Altered lipid metabolism (decreased levels of enzyme lipoprotein lipase - breaks down lipoproteins)
Manifestations
Electrolyte/Acid-base imbalances
Potassium (hyperkalemia) - fatal dysrhythmias when serum K level is 7-8 mmol/L
Sodium (normal/low) - retained with water
Calcium and phosphate alterations
Magnesium alterations (hypermagnesemia)
Metabolic acidosis (inability for kidneys to excrete acid load, defective reabsorption of bicarbonate)
Manifestations of hypermagnesemia
absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, respiratory failure
Manifestations
Hematological System
Anemia
Bleeding tendencies
Increased susceptibility to infection
Anemia in CKD
Very common
Increased production of erythropoietin, nutritional deficiencies, increased hemolysis of RBCs, frequent blood sampling, GI bleeding
Erythropoietin
hormone that stimulates RBC production in bone marrow
elevated PTH levels (d/t low serum calcium) inhibits this hormone
Bleeding tendencies
Defect in platelet function
Increased infection CKD
Changes in leukocyte function
Altered immune response
Diminished inflammatory response
Manifestations
CVS
HTN HF L ventricular hypertrophy Peripheral edema Dysrhythmias Uremic pericarditis
Manifestations
Respiratory System
Kussmaul's resps Dyspnea Pulmonary edema Uremic pleuritis Uremic pneumonitis Pleural effusion Predisposition to respiratory infection
Manifestations
GI System
Inflammation of mucosa related to excessive urea
Constipation (limited fluid intake)
Symptoms of inflammation of mucosa in GI
Stomatitis with exudates and ulcerations
Uremic fetor (urinous odour of breath)
GI bleeding
Manifestation
Neurological System
Restless leg syndrome depressed speaking muscle twitching fatigue, irritability Apathy Decreased ability to concentrate Peripheral Neuropathy
Manifestations
Musculo-skeletal system
Mineral and bone disorder
Bone abnormalities, changes in mineral balance, vascular and other soft tissue calcifications
results in renal osteodystrophy and vascular and soft tissue complications
Manifestations
Pruritus
Uremic frost
Manifestation
Reproductive System
infertility
decreased libido
low sperm counts
sexual dysfunction
Manifestations
Psychological Changes
Personality and behavioral changes
emotional lability
Withdrawal
Depression
5 stages of CKD
Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)
Diagnostic studies for CKD
Urinalysis dipstick (proteinuria +1, 2 or more times in 3 month period) Albumin-creatinine ratio (proteinuria) Renal ultrasound Xray KUB CT KUB Renal biopsy
Most important risk factor
Protein in the urine
People that should be screened for proteinuria
DM HTN vascular disease autoimmune diseases GFR <60 edema
Specific gravity
1.005-1.030
Measure of conc. of solutes in the urine
Shows kidneys ability to create urine
Urine pH
4.6-8
Bilirubin
Product of RBC breakdown
Indicates liver disease
Casts
Indicates kidney health
Labs
BUN
Creatinine
Creatinine Clearance
GFR
Creatinine
nitrogenous waste produced from muscle metabolism
elevated in CKD
Creatinine Clearance
used to assess GFR
how efficiently kidneys clear creatinine from the blood
GFR
determines how fast blood is filtered through the glomerulus
Management measures (when everything else has failed)
prepare patients for renal therapy and transplantation
Correction of extracellular fluid volume overload or deficit
Nutritional therapy
Erythropoietin therapy
Calcium supplementation (phosphate binders)
Antihypertensive therapy
Measures to lower potassium
Adjustment of drug doses to degree of renal function
Drug therapy
Hyperkalemia
Calcium gluconate (stabilize myocardium)
B-B2 adrenergic agonists (shift potassium into the cells)
IV insulin (shift K into cells)
IV glucose to manage hypoglycemia
Kayexalate
Diuretics or dialysis
Hypertension tx (with CKD)
Sodium and fluid restriction
Antihypertensive drugs (loop diuretics, CCB, ACE, ARB)
CKD MBD tx
Phosphate intake restricted to <1000mg/24 hrs
phosphate binders
Supplementing vit D (phosphate has to be normal first
Controlling secondary hyperparathyroidism
Anemia tx (with CKD)
Erythropoietin
iron supplements
folic acid supplements
avoid blood transfusions
Dyslipidemia tx (with CKD)
Statins in clients in stage 1-3 CKD
Drug toxicity tx (with CKD)
Digoxin
oral glycemic agents
antibiotics
opioids
NO NSAIDS (acetaminophen instead)
