ESRD Flashcards
hyperphosphatemia in ESRD
Clinical features of PD related peritonitis is
due to touch contamination from skin bacteria or catheter related infeciton
Presentation of PD peritonitis
Diagnosis is via
abdominal pain, low grade fever and nausea
on physical exam: abd tenderness and cloudy abdominal fluid and rebound tenderness
Diagnosis is peritoneal fluid >100 WBC and fluid with >50% neutrophils regardless of absolute WBC count
Treatment of PD related peritonitis:
IV vancomycin and 3rd for 4th generation cephalosporin (cefepime) or an aminoglycoside
only remove PD catheter if there’s a tunnel infection or refractory intraperitoneal infections.
acquired cystic kidney disease
from ESRD on dialysis.
okly are likely develop renal cell carcinoma and 5 year mortality is increased because of associated with ESRD and dialysis.
nephrogenic systemic fibrosis is
complication of gadolinium exposure in a ESRD when they get an MRI with contrast,
skin becomes thickened like sclerosis and irreversible.
Try to get non contrast MRI instead
If exposed need to get HD as ssoon as possible as gadolinium exposure within hours is recommended to reduce the risk for nephrogenic systemic fibrosis.
gadolinium can deposit in the brain and bone and dose dependent fashion in individuals with normal kidney function.
CRRT vs HD
CRRT- continuous renal replacement - type of dialysis that is performed in critically ill pts who are hemodynamically unstable.
CRRT - provides hemodynamic stability by removing fluid and solutes at a much slower rate than IHD.
CCRT is not able to clear potassium rapidly but may be considered in a pt who cannot tolerate HD or even intermittent HD.
If getting a peripheral PICC line, for IV access for antibiotics for osteomyelitis what do you do in a CKD 4 pt?
no picc line
rather use a central line
PICC have significant vein trauma and venous stenosis in the vein that may be used for AV fistula formation.
