Kidney diseases Flashcards
Is kidney injury a slow process?
NO - rapid progression
Fxn of kidneys
F&E homeostasis, rid body of water-soluble waste (many drugs) via urine, endocrine functions like making erythropoietin, activating vit D, making renin (regulate BP)
Is kidney injury reversible?
It can be
What is GFR a measure of?
how well the kidneys are working; insufficiency is 25% of normal GFR
Are kidneys greedy?
Yes - require 1L/minute of blood (20% CO)
AKI
body causes inflammation when it sense injury causing inc kidney cell death
Causes of AKI
ischemic injury r/t loss of blood volume and dec perfusion from toxins (OD) or sepsis (3rd space), acute blood loss
Pre-renal AKI
volume loss (surgery) or dehydration
- most common
intrarenal AKI
acute tubular necrosis (drug OD, kidney cell death), vascular disease, glomerulonephritis
post-renal AKI
not as common, obs causes cell death, tumor; in ureter or bladder
CM of AKI
1st day after hypotensive event and lasts 1-3 weeks; oliguria, FVE (edema), metabolic acidosis, hyponatremia, hyperkalemia, waste product accumulation, neuro dx
Oliguria of AKI
under 400 mL/24h or under 30 mL/1h
Tx for AKI
address cause, fluids, drug antidote, electrolytes, address fluid shift
What determines the stage of injury with CKD?
GFR
Stage 5 CKD
urinemic - urea in blood; excess AA in metabolic end products
- urine in blood bc body can’t excrete
Best tx for CKD
Prevent by controlling causes (often chronic conditions like DM - 1, HTN - 2, glom or AKI, other probs)
Risks for CKD
family history, CAD, HLD, atherosclerosis, older than 60Y, men, Black, HTN, DM, SMOKING, overwt and obese
Patho of CKD
lack BF to kidney cells and proteinuria from leaky GBM accumulates in the interstitial space in nephrons, causing injury; inflammatory system activated and angiotensin 2 activates, causing arterial vasoconstriction which normally would inc glom HTN but due to the leaks it causes more proteinuria
CM of CKD
Most body sys are affected by waste products from the kidneys are everywhere
- inc systemic inflammation
Integumentary sx of CKD
itchy, red, dry, scaly
Psych sx of CKD
anx and dep
Neuro sx of CKD
fatigue, HA, sleep prob, encephalopathy
CV sx of CKD
heart failure, HTN, CAD, pericarditis, PAD
GI sx of CVD
anorexia, N/V, gastritis, bleeding
What sign of CVD indicates dialysis is needed?
Pulmonary edema - biggest concern
CKD fx of poor F&E homeostasis
edema, INC K, inc P, and inc Mag, metabolic acidosis
CKD CM of no waste ridding
anorexia, malnutrition, itching, CNS change from things crossing BBB (AMS), uremic frost
CKD fx of dec erythropoitein
anemia; gradual adjustment to hgb of 5 or 6
CKD fx of dec activation of vit D
renal osteodystrophy, weak bones
Drugs used to slow progression of CKD
ACE inhibitors OR ARBs - keep BP under 140/90
Tx HLD (under 200) with statins, diet
How to tx CKD
Tx the symptoms and complications with usual tx - overload (diuretics and low salt), inc K (hemodialysis, Kayexalate), acidosis (NaHCO3), hyperphos (phosphate binder like Calcium carbonate) anemia (erythropoitein), renal osteodystrophy (calcitriol–activated vit D)
Drug monitoring with CKS
- dec drug elimination with CKD
- monitor levels closely - may need to adjust to kidney fxn - RENALLY DOSED
Which drugs do you need to watch closely with CKD?
Digoxin, diabetic agents like glyburide, Metformin, abx like VANC, opioids (can cause severe resp dep bc kidneys won’t clear it)
Normal GFR
Over 90
Stage 1 and 2 CKD CM
Often asymptomatic
Stage 3 CM
HTN - tx it
Why don’t we want to lower BP too much?
Kidneys won’t get perfused at the rate that they are used to - slow titration
- goal is SBP 110-130
