CKD Cases Flashcards
1,2 . List alterations in multiple organ systems associated with CKD and the pathophysiology of these alterations.
metabolic: edema/hypoalbuminemia; excess insulin due to reduced breakdown in kidney
CV complications (uremic toxins)- pericarditis and tampanade
hematologic- anemia
endocrine: Vit D shortage and Ca/P deposition
GI: uremia can lead to anorexia
Lungs: fluid overload can cause CHF due to poor filtration
- Describe the rational therapies for these alterations based on the known patholphysiology; when do you employ dialysis?
dialysis in the case of hyperkalemia >6.5, symptomatic uremia, unresponsive acidosis, and sodium /fluid overload or unresponsiveness
- Describe appropriate therapies for slowing of CKD progression.
control diabetes (metformin?)
add an ACEI to reduce sclerosis and glomerular pressure, tx goal to reduce proteinuria to 1g/d
restrict protein to 0.6-0.8g/kg ideal body weight
manage pH with NaHCO3
supplement EPO and iron for anemia
protect bone health and counter
parahyperthyroidism with 1,25 OH Vit D and limit phosphorus intake/ use phosphrous binders
Why is albumin low in someone who is undergoing peritoneal dialysis?
may not be eating (poor intake)
protein losses from abdomen
systemic inflammation
urinary losses
