kidney #1 Flashcards

Question

CKD: Pathophysiology

Answer 1

—Progressive loss in function: —gradual ⇓ in # of functioning nephrons —Cause may initially adversely affect either glomeruli or tubules - eventually effects the whole nephron —Fewer remaining functional nephrons ↑ in size and function (compensatory) —eGFR gradually ⇓ —Often onset not obvious until a large % of renal function lost

Answer 2

—Stage 1 - > 90 ml/min —Stage 2 – 60 – 89 ml/min Stage 3 - 30 – 59ml/min malnutrition potential begins — Stage 4 - 15 – 29 ml/min —Stage 5 - < 15 ml/min —Stage 5 = end-stage renal disease →kidney transplantation or dialysis is required for life. dont always wait until stage 5 to start dialysis, can start before normal GFR is 130-150ml/min

Answer 3

—Early on, may be polyuria or nocturia (depends on cause), but progresses to oliguria/anuria/dysuria —Foamy urine/tea coloured —fatigue —itching —anemia —swelling of hands and feet —shortness of breath —bad taste in mouth (can be imporatnt in nutrition)—cold intolerance —nausea, vomiting, anorexia (uremia = buildup of urea / other byproducts of protein metabolism) —Untreated uremia ⇒ CNS (abnormal behavior, coma)

Answer 4

Contributors are- 1) acidosis 2) excess PTH 3) altered vit D metabolism

Answer 5

—Control blood pressure —Detect microalbuminuria, and treat with drug therapy to slow progression —Control HbA1c —Cease smoking, reduce dyslipidemia Treatments we will discuss: —Nutritional care —Also relate to medications and supplements —Dialysis —(Renal Transplants)

Answer 6

—2 types: —Hemodialysis —Peritoneal dialysis

Answer 7

—an "artificial kidney machine" or dialyzer removes unwanted substances from the blood stream. —the blood from an artery in an arm or leg circulates through the machine (and membrane) and is then returned to the parallel vein. i.e. permanent access to bloodstream is needed. —Figure 18.5, 18.6 Different forms of vascular access. —The semi-permeable membrane is permeable to water and compounds of low MW, such as potassium, sulfate, urea, creatinine, uric acid. —Substances of higher MW cross the membrane more slowly. —The membrane is impermeable to blood cells and most plasma proteins. —The rates & amounts of fluid and waste products removed can be varied by using different: a) membranes b) blood flow rates c) dialysate concentration —Commercial solutions, and their composition can be modified as needed. —Many substances will need to diffuse along a concentration gradient. —For example, the dialysate will have lower K than serum. —Glucose is often included in the dialysate to prevent hypoglycemia. —Excess fluid is removed (by ultrafiltration). —A hydrostatic pressure gradient across the membrane is increased with pumps to get rid of excess fluid. -Goal of hemodialysis : clear waste products and fluid down to nearly normal levels by the end of treatment → these will gradually return to ↑ levels between treatments. —Usually done at hospital centers —Some at home. —Usually dialysis 2-3x/week for ~ 3-6 hours each time.

Answer 8

a) membranes b) blood flow rates c) dialysate concentration

Answer 9

—Uses the peritoneum as the selective, semipermeable membrane for dialyzing. —What is the peritoneum? —Dialysate enters the peritoneal space through a catheter penetrating the abdominal wall → clamped so that the fluid remains in the peritoneum → drain it after a given amount of time. —Fig 18.7 —Relies on exchange with plasma circulating in the capillaries that are perfusing the peritoneal wall. —Principles similar to hemodialysis except that the dialysate contains enough glucose to make it hypertonic relative to plasma. —→ causing fluid to flow into the peritoneal cavity ( a way to rid excess fluid). —Efficiency of dialysis determined by: a) concentrations in the dialysate b) dwell time Two major types: 1) Continuous Ambulatory Peritoneal Dialysis (CAPD) —Uses repeated infusions of dialysate into the peritoneal space. —The dialysate stays in the peritoneal space for 4-6 hours at a time (waste products diffuse into the dialysate). —Then drained by gravity, and the procedure is repeated (continuously). —A long dwell time overnight. 2) Continuous Cycling Peritoneal Dialysis (CCPD) —a machine does repeated timed cycles of infusion, dwell, and drain at night (automatically). —Dialysate left in the peritoneal cavity during the day.

Answer 10

a) concentrations in the dialysate b) dwell time

Answer 11

1) Continuous Ambulatory Peritoneal Dialysis (CAPD) —Uses repeated infusions of dialysate into the peritoneal space. —The dialysate stays in the peritoneal space for 4-6 hours at a time (waste products diffuse into the dialysate). —Then drained by gravity, and the procedure is repeated (continuously). —A long dwell time overnight. 2) Continuous Cycling Peritoneal Dialysis (CCPD) —a machine does repeated timed cycles of infusion, dwell, and drain at night (automatically). —Dialysate left in the peritoneal cavity during the day.