CKD & dialysis/transplant Flashcards
using eGFR numbers, define CKD stages 0 through 5
0 is normal GFR, normal urine
1. GFR over 90
2. GFR under 90
3. GFR under 60
4. GFR under 30
5. GFR under 15
4 most common causes of CKD
DM
HTN
GN
cystic kidney disease
2 screening tests for CKD
eGR under 60
ACR over 30
having these values for more than 3 months = CKD
3 main ways to prevent CKD progression
control BP (can use ACEi or ARB)
manage DM
avoid insults to kidney
4 things that are kidney insults
IV contrasts
NSAIDs
dehydration
other nephrotoxic meds
when should PCP get nephro involved (3)
- stage 4!
- too fast of progression
- over 3.5g of proteinuria
why can ACEi be used in to treat kidney dz? what lab should you monitor when starting it?
- it dilates the efferent arterioles which decreases glomerular pressure, reducing injury, GFR & proteinuria = prolonged kidney life
- check creatinine for 2 wks– if it goes up by more than 25% stop it!!
2 reasons we typically dont use 2 RAAS inhibitors
- hyperkalemia
- drops GFR too much
4 ways CKD affects CV system
- HTN
- volume overload
- Calcium metabolism issues
- proteinuria
#1 cause of death from CKD; leads to heart failure, CAD, arrhythmias
how does CKD affect bone mineralization? 3 ways to treat it
- if it cant make activated vit D then GI cant absorb Calcium causing hypocalcemia. this causes PTH oversecretion so body takes Ca from bones.
- tx: 200IU PO qd D3, limit phosphorous in CKD 4/5, +/- phosphate binders
two electrolyte disorders we see in CKD
metabolic acidosis
hyperkalemia
how is hyperkalemia managed (4)
- reduce dietary K+
- stop NSAID, COX-2i, K+ sparing diuretics
- stop or reduce BB, ACEi/ARBs
- avoid salt subs that have K+
two ways to manage anemia in CKD
- ferritin (start if under 500) & TSAT (keep over 20), oral (non-dialysis) & IV (dialysis) iron repletion
- Epogen replacement– target Hb over 11.5 g/dL, replace iron stores before giving Epogen.
5 uremic sx to screen & educate patients about
- AMS
- metallic food taste
- pericarditis
- pruritis
- N/V, anorexia
how does the urea level change with GFR changes
urea increases as GFR declines
8 meds that you must do dose adjustments in pts w/ CKD
Allopurinol
Gababentin
Reglan
Narcotics
Insulin– hypoglycemia
Antimicrobials
MTX
Digoxin & other heart meds
4 main indications for dialysis!
volume overload
hyperkalemia
metabolic acidosis
uremia
3 principles of dialysis
- diffusion: gets urea and K+ out & moves Ca and bicarb in
- ultrafiltration: pressure in blood to get water out
- convection: to get the bigger molecules out
best access for hemodialysis done via fistula or grafts
aterio-venous access
2 types of hemodialysis
acute & chronic (diff of 3 months)
hemodialysis vs perioneal dialysis– which one?
Blood is filtered using an extracorporeal circuit and artificial membrane
hemodialysis
hemodialysis or peritoneal dialysis– which one
Blood is filtered using native intra abdominal vessels and peritoneal membrane; Must be done every night
peritoneal dialysis
3 dialysis related complication
- hypovolemia
- alkalemia
- hypotension: ultrafiltration > plasma refill
4 access related dialysis complication
- nonfunction, infections
- steal syndrome (AVF> AVG)
- high output heart failure (AVF)
- central venous stenosis (catheters)
what is the condition
all blood goes to vein causing gangrene; need to check blood flow in digits & treated by decreasing blood inside fistula
steal syndrome (AVF > AVG)
blood is coming back to heart right away without going to other vessels straining the heart
high output heart failure (AVF)
what replacement therapy has these benefits?
- Relatively unrestricted diet
- Freedom to travel
- Fertility restoration
- Return to employment
- Lifestyle free of dialysis constraints
- cost effective
transplant
what replacement therapy? what are 3 cons to it?
- better lifestyle, mental satisfaction & economics
- maintains renal function & less cardiac effects
- patient controls it
- preferred to start with
peritoneal dialysis
cons: peritonitis, membrane failure, uncontrolled diabetes
what replacement therapy has these benefits? 4 cons to this method?
- better volume control; predictable performance
- used only 3x/wk
- no issues w/ blood sugar control
hemodialysis
cons: lifestyle restrains, access infections, loss of residual renal fx, cardiac stunning
which replacement tx has higher mortality than lung cancer after 5 years?
hemodialysis
these are signs of what
Tenderness or pain over the kidney transplant; general achy feeling
peripheral swelling
elevated temp, increase in BP or Cr
rapid weight gain.
decrease in urine output
acute rejection in kidney transplant
