CKD 2 Flashcards

1
Q

causes for complications of CKD

A

pro-inflammatory state (uremia)

multiple electrolyte abnormalities

vascular stress

tissue dysfunction due to build up of waste products

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2
Q

CV effects of uremic syndrome

A

3.5x CVD mortality

CAD contributes to cause of death

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3
Q

CAD causes death in CKD why

A
  1. severe CAD develops (pro inflammatory state, hypertriclygeridemia, vascular stress)
  2. multiple co-morbidities makes disease more severe
  3. our reluctance to investigate and fully treat
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4
Q

heart disease and uremia

A
  1. high rate of accelerated and recurrent stenosis of coronary arteries
  2. metastatic calcification of valves and pericardium due to secondary hyperparathyroidism
  3. chronic anemia increases workload
  4. additional cardiovascular stress of HD
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5
Q

pericardial effusion and pericarditis

A

buildup of metabolic toxins

s/s: 
evidence of fluid overload 
chest pain
fever
friction rub
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6
Q

why does heart failure occur so easily in CKD?

A

uremic state

accelerated CAD

LVH/dilation

fluid overload

anemia

AV shunt

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7
Q

general rules for HF and uremia tx

A

managed by ACE/ARB and diuretics

  1. monitor K, Cr
  2. higher diuretic doses
  3. watch for toxicities
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8
Q

GI effects of uremic syndrome

A

occur early and frequently

  1. metallic taste, N/v anorexia
  2. weight loss (Decreased intake and catabolism)
  3. gastritis
  4. GI bleeding
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9
Q

CNS early effects in CKD

A

progressive cognitive dysfunction

memory problems

sleep disturbances

decreased DTR and vibratory sensation

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10
Q

late effects in CKD

A

lethargy, irritability, asterisks

frank encephalopathy

seizures

peripheral neuropathy

autonomic neuropathy

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11
Q

3 types of anemia seen in CKD

A
  1. anemia of chronic dz (decreased erythropoietin)
  2. iron def. anemia
  3. anemia of chronic disease

microcytic

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12
Q

treatment of anemia in CKD

A

Fe supplement and recombinant erythropoietin

HgB goal of 10 (too much = pro clotting)

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13
Q

bleeding diathesis

A

coagulopathy due to platelet dysfunction

  1. mild to mod decrease in platelet count
  2. abnormally poor platelet adhesiveness and aggregation
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14
Q

endocrine effects of uremia

women

A

decreased estrogen and progesterone levels

cycles are anovulatory

low libido and vaginal bleeding

pregnancy is rarely possible and fetal death occurs

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15
Q

endocrine effects of uremia

men

A

low levels of testosterone

result in impotence and low libido

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16
Q

immune effects of uremia

A

humoral and cellular immunologic dysfunction

late CKD considered relatively immunosuppressed

more likely to get rare/fungal infection

17
Q

metabolic derangement in CKD

A

diabetic patients may require more or less insulin due to increased tissue resistance and decreased renal clearance respectively

lipid abnormalities (high trigs, accelerated arteriosclerosis)

18
Q

skin derangement in CKD

A

yellowish skin

pruritus

nails: brown discoloration of distal nail bed, splinter hemorrhages, pale

19
Q

NSF

A

caused by allergy to gadolinium contrast

symmetrical, bilateral fibrotic indurated papules, plaques, or subcutaneous nodules +/- erythema

first develops on ankles, lower legs, then move proximally

preceded by edema

20
Q

NSF management

A

pathophys unknown

diagnosis of skin biopsy

chronic and unremitting

avoid gadolinium w/ GFR <30-44

21
Q

secondary PTH

A

excretion of Ca++ in place of phosphorus

causing increased levels of PO4, decreased serum levels, stimulates PTH secretion

mobilizes calcium form bones to maintain normal levels

low bone turnover rates and decreased/absent bone formation

Parathyroid glands are hyperplasia

failing kidney can’t make vitamin D so absorption decreases

22
Q

renal osteodystrophy

A

demineralized bones due to CKD

characterized by

bone pain, osteomalacia
spontaneous fracture
muscle weakness
metastatic calcifications

23
Q

nonskeletal secondary hyperparathyroidism (6)

A
cardiovascular calcification 
soft tissue calcification 
endocrine disturbances 
compromised immune system 
neuro-behaviroal changes
altered eryhtopoiesis
24
Q

another cause of secondary hyperparathyroidism

A

vitamin D deficiency

unable to absorb calcium from diet resulting in overstimulation of parathyroid

its with CKD have both etiologies due to poor renal activation of vitamin D

25
labs of secondary hyperparathyroidism
LOW serum Ca HIGH serum PTH HIGH serum phosphate
26
treatment of secondary hyperparathyroidism
1. reduce intake of phosphates 2. place on phosphate binders 3. normalization of vitamin D levels 4. sensitivity change of PT receptors
27
phosphate binders
taken with meals, bind to injected phosphates and pass them thru GI without absorption
28
phosphate binders used (brand + generic)
1. calcium acetate (phoslo) 2. selevamer (renvela, renegel) 3. fosrenol (lanthanum) 4. sucroferric oxyhydroxide (velphoro)
29
medication given to normalize vitamin D levels
1. Calcitriol (Rocaltrol) - ACTIVE vitamin D metabolite 2. Doxercalciferol (Hectorol) - must be metabolized 3. Paricalcitol (Zemplar) - binds to vitamin D receptor
30
Cinacalcet
Sensipar calcimimetic, enhances sensitivity of parathyroid calcium receptor tricks receptor into thinking lower level is acceptable
31
surgical treatment of secondary hyperparathyroid
partial removal (3.5 glands) total parathyroidectomy
32
tertiary hyperparathyroidism
occurs in patients with longstanding CKD following renal transplant
33
tertiary hyperparathyroidism pathophys
parathyroid glands have been excessively active for several years by CKD fail to recognize normalization of serum calcium levels after renal transplant and parathyroid is autonomously producing PTH
34
treatment of tertiary hyperparathyroidism
resistant to calcimimetics calcifications occur in body tissue total or subtotal parathyroidectomy
35
hungry bones
severe hyperparathyroidism pt has parathyroidectomy post-op bone resorption remains same, and bones are hungry its suffer repeated episodes to hypocalcemia despite supplementation
36
symptoms of hungry bones
symptoms of hypocalcemia parasthesia in finger and mouth seizures
37
hyperkalemia (levels and tx of MILD)
significant >5.5 need to r/o hemolysis oral or rectal K binder (Kayexalate)
38
severe hyperkalemia treatment
IV calcium gluconate hemodialysis