Frush

Question 1

PAD and Renal disease

Answer 1

• As RENAL FUNCTION DECREASES, phosphate levels INCREASE
  
  • calcium and phosphorus deposit in the vascular bed leading to CALCIFIED VESSELS
• ESRD linked with hyperparathyroidism
• High C reactive protein (CRP) contributes to PAD

Question 2

Neuropathy and renal disease

Answer 2

• Uremia on its own can cause neuropathy
  
  • shows similar distribution as diabetic neuropathy
• Autonomic neruopathy occurs in 45-60% of patients
  
  • postural hypotension
  • shunting of cutaneous capillary beds
  • atrophy of sebaceous and sweat glands

Question 3

Infections and Renal disease

Answer 3

• uremia can cause IMMUNE DYSFUNCTION
  
  • impairs polymorphonuclear cells (impaired resistance ot bacteria)
  • Impaired T cell function
• LEADS TO HIGHER RATE OF POLYMICROBIAL INFECTION

Question 4

Acquired perforating dermatosis

Answer 4

• transdermal elimination of material from dermis
• scattered cone shaped and plugged keratotic papules, plaques and nodules
• often found in high friction areas (lower extremities most common)
• pink in fair skin, brown in darker skin
• TX is corticosteroids

Question 5

Porphyria cutanea tarda

Answer 5

• disorder of heme biosynthesis
• vescicles (small blisters) erupt in sun exposed areas
• TX;
  
  • manage iron overload
  • minimize sun exposure
  • minimize any photosensitizing meds

Question 6

Calcinosis Cutis

Answer 6

• firm papules, plaques or nodules
  
  • can exude white chalky substance
• found near joints or on fingertips
• TX management of calciuma nd phosphorus levels

Question 7

calciphylaxis

Answer 7

• High incidence in
  
  • dialysis pts
  • hyperparathyroid patients
  • combined
• Get calcification and obstruction of Small and medium cutaneous vessels
• hyperplasia of tunica media and tunica intima
• Septal and lobular subcutaneous necrosis
• LEADS tO DIStAL ISCHEMIA, PAINFUL ULCERS AND AMPUTATION
• TX = debridement and wound care and controlled diet

Question 8

Nephrogenic systemic fibrosis

Answer 8

• seen i pts with ESRD with exposure to gadolinium
• Starts in lower extremity first –> can move up to trunk (spares head)
• Bilateral FIBROTIC or BRAWNY induration of the skin
  
  • thickened, indurated erythematous raised skin lesison
  • Peau de orange appearance
• Can lead to permanent contractions

Question 9

Uremic pruritus

Answer 9

• severe itching skin
• Excessive scratching leads to beraks in skin which may lead to infection
• NALFURAFINE and NALTREXONE can be helpful to reduce itching

Question 10

Nutritional deficits

Answer 10

• Albumin –> building blocks for wound healing
• Zinc
  
  • needed for keratinocyte migration
  • protects against apoptosis

Question 11

Depression an renal disease

Answer 11

• 20-30 of hemodialysis patients suffer from depression
  
  • leads to DECREASE in care
    
    • less self monitoring
    • missed appointments
    • compliance decreases