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FA17 Nephrology > CKD 2 > Flashcards

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
Q

labs of secondary hyperparathyroidism

A

LOW serum Ca

HIGH serum PTH

HIGH serum phosphate

26
Q

treatment of secondary hyperparathyroidism

A
  1. reduce intake of phosphates
  2. place on phosphate binders
  3. normalization of vitamin D levels
  4. sensitivity change of PT receptors
27
Q

phosphate binders

A

taken with meals, bind to injected phosphates and pass them thru GI without absorption

28
Q

phosphate binders used (brand + generic)

A
  1. calcium acetate (phoslo)
  2. selevamer (renvela, renegel)
  3. fosrenol (lanthanum)
  4. sucroferric oxyhydroxide (velphoro)
29
Q

medication given to normalize vitamin D levels

A
  1. Calcitriol (Rocaltrol) - ACTIVE vitamin D metabolite
  2. Doxercalciferol (Hectorol) - must be metabolized
  3. Paricalcitol (Zemplar) - binds to vitamin D receptor
30
Q

Cinacalcet

A

Sensipar

calcimimetic, enhances sensitivity of parathyroid calcium receptor

tricks receptor into thinking lower level is acceptable

31
Q

surgical treatment of secondary hyperparathyroid

A

partial removal (3.5 glands)

total parathyroidectomy

32
Q

tertiary hyperparathyroidism

A

occurs in patients with longstanding CKD following renal transplant

33
Q

tertiary hyperparathyroidism pathophys

A

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
Q

treatment of tertiary hyperparathyroidism

A

resistant to calcimimetics

calcifications occur in body tissue

total or subtotal parathyroidectomy

35
Q

hungry bones

A

severe hyperparathyroidism pt has parathyroidectomy

post-op bone resorption remains same, and bones are hungry

its suffer repeated episodes to hypocalcemia despite supplementation

36
Q

symptoms of hungry bones

A

symptoms of hypocalcemia

parasthesia in finger and mouth
seizures

37
Q

hyperkalemia (levels and tx of MILD)

A

significant >5.5

need to r/o hemolysis

oral or rectal K binder (Kayexalate)

38
Q

severe hyperkalemia treatment

A

IV calcium gluconate

hemodialysis

FA17 Nephrology (13 decks)

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