Complications and Management of CKD Flashcards
Causes of hyperkalemia in CKD
- increase in total body potassium.
- due to reduced excretion because of reduced ___ or ____ with certain conditions like ___ and medications like ___, ___ and ___ - Shifts from ____ fluid to ___ fluid because of ___ _
Causes of hyperkalemia in CKD
- increase in total body potassium.
- due to reduced excretion because of reduced GFR or ALDOSTERONE with certain conditions like DIABETES and medications like ACEi, ARB, MRA–> ones that impact the RAAS system - Shifts from INTRACELLULAR fluid to EXTRACELLULAR fluid because of ACIDEMIA
why is managing hyperkalemia important?
3 broad causes as to why metabolic acidosis happens in CKD
- inadequate excretion of ammonia
- reduced excretion of titratable acid
- reduced tubular reabsorption of bicarbonate
why is fixing metabolic acidosis important?
can leas to
- increased risk of osteoporosis
- associated with malnutrition syndrome
- asscoiated with insulin resistance and hypertriglyceridema
- assocaited with systemic inflammation
- assocaited with progression of CKD
why does volume expansion happen in CKD
because of increased sodium retension which causes water retension
- sclerosed glomeruli cause inceased renin secretion, which increses angiotensin III and aldosterone.
can lead to hypertension and poor cardiovascular outocmes
why does anemia happen? (5 causes) outline the anemia in CKD
- because of redcued erythropoietin production.
usually, the kidney can detec hypoxia and induce EPO expression, but in damaged kdineys, they can’t produce EPO and rbcs are not able ot be made.
- there is a reduced RBC life span
- increase GI blood loss
- absolute and relative iron deficinecy
- REDUCED HEPCIDIN sequestered in the liver
a reduced GFR can lead to elevated ___, low ___ and Low vitamine __. these all lead to mineral and bone disorders.
- it happens because of elevated ___ and ___.
elevated phosphate, low calcium and low vitamin D.
it happens because of elevated pth and fgf23.
this causes abnormal bone turnover, soft tissue calcification, vascular calcification and tertiary hyperparathyroidism
What types of changes in bone?
• Osteitis fibrosa cystica= Excess ___ causes bone break down
- Adynamic bone disease= Excess __ __ causes lack of bone turn over
- Osteomalacia= Lack of normal __ due to previous use of __ based medications
- Mixed uremic __
- Osteitis fibrosa cystica= Excess PTH causes bone break down
- Adynamic bone disease= Excess PTH suppression causes lack of bone turn over
- Osteomalacia= Lack of normal mineralization due to previous use of aluminum based medications
- Mixed uremic osteodystrophy
why does CVD happen in CKD?
increased incidence of traditional risk factors like DM, dyslipidemia, hypertension, vascular clacification, pro inflammatory state because of other organ injury, left ventricular hypertyrophy.
leading cause of death in stage 4 and 5 CKD
cardiovascular diseaseq
why does uremia happen in CKD
- accumulation of endogenously produced subsances, due to LACK OF RENAL CLEARANCE OR INCREASED PRODUCTION.
symptoms and physical exam findings of uremic syndrome
decreased LCO, confusion, decreasd appetite, nausea, vomiting, volume overload, increased risk of bleeding, elecrtolye and pericarditis
4 key lifestyle finidings of preventing CKD progression
- low salt diet <2grams per day
- low protein diet (.8grams/kg)
- exercise, 30 minutes activity 5 times per week
- smoking cessation
pharmacologic management of CKD WITH PROTEINURIA to prevent progression
if ACR >30
- ACEi or ARB
1. SGLT2 inhibitor
- ACEi or ARB
pharmacologic prevention of CKD progression with no proteinuria. Which medication classes to avoid?
- blood pressure control: for diabetes <130/80, for non diabetes <120?? (shouldn’t be 140)
- diabetes contro
- med adjustment: AVOID NSAIDS, adjust antibiotic and gout medication use
- reduce the risk of AKI; maintain hydration
- contrast administration contraindicated
life style management of hyperkalemia
low potassium diet
emergent management of hyperkalemic
- if there are ECG changes or respiratoyr depression, this is emergent. need to stabilize the cardiac membrane, shift and excretew
non-emergent management of hyperkalmia
potassium binders
regular bowel movements
diuretics
lifestyle management of metabolic acidosis
lifestyel: diet with fruits and vegetables along with lor protein diet
pharmacologic management of metabolic acidosis
oral sodium bicarbonate supplementation. target serum CO2 21-24
lifestyle modification to prevent volume expansion
- low salt diet
- fluid restriction <1.5 liters/day, daily weights
pharmacologic volume expansion management
- LOOP diuretics; can add in thiazide diuretics for refractory cases
- renal replacement therapy if completely refractory.
pharmacological managemnet of anemia in CKD. What two classes?
- oral or IV iron to achieve a beter transferrin saturation/adequate iron stores
- erythropoietin supplementaion. consider if hemoglobin is under 90, target 100-115. can use erythropoisesis stimulating agents (ESA) like eprex, or hypoxia-induved factor (HIF) stabilizer
life style management of mineral and bone disorders. what mineral should you limit?
low phosphate diet!!
pharmacological management of mineral and bone disorder
- phosphate binders taken with food to promote gut phosphate excretion.
- PTH inhibition via LOTS OF VITAMINE D. if there is a reduced vitamin D, PTH is on. you need vitamin D to prevent PTF overactivation
surgical management of mineral and bone disorders
parathyroidectomy
note: cardiovascular disease management in CKD
what is this and mechanism of injury
calciphylaxis. extreme soft tissue damage because calcium lays in the blood vessels and causes them to stenose. we see necrosis of soft tissue.
- often first looks like a bruise. often high mortality
management of uremic syndrome
Renal replacement therapies
• Hemodialysis
• Peritoneal dialysis
• Transplant
