Kidneys Flashcards
Renin
kidney blood pressure hormone. It helps control how much sodium (salt) and fluid the body saves and how relaxed the blood vessels are. People with kidney disease usually need blood pressure pills because their kidneys no longer control blood pressure.
Erythropoietin (EPO)
kidney hormone that tells the bone marrow to make new red blood cells (using stem cells). Many people with kidney disease have anemia, a shortage of red blood cells, that makes them feel very tired. Injections of EPO are used to treat anemia, along with iron.
Calcitriol
activated form of vitamin D
a hormone that helps the body absorb calcium from food. Without calcitriol, the body steals calcium from the bones. Over a long period of time, this can cause bone disease. Calcitriol injections or pills are used to help avoid bone disease in people with kidney disease.
Amount of fluid/waste filtered
2 quarts
Causes of kidney failure
#1 - Type 2 diabetes #2 - hypertension (Normal BP = 120/80; Normal BP in CKD
Weight of kidney
5 ounces
size of fist
Acute Renal Failure (ARF)
sudden loss of kidney function caused by an illness, injury, or toxin that stresses the kidneys. Many cases of ARF can be treated and reversed.
Chronic Kidney Disease (CKD)
CKD is a long and usually slow process where the kidneys slowly lose function
More than 75% of the one million nephrons in each kidney must be damaged to cause illness. This means that small declines in renal function do not cause a problem right away. It can take many years to go from CKD to ESRD.
End-Stage Renal Disease (ESRD)
When the kidneys function at 15% or less
Warning Signs of CKD
Changes in urination – like foamy urine, blood in the urine, more or less urine than usual, or getting up at night to urinate
Fatigue – lack of usual energy and feelings of overwhelming tiredness can be related to kidney failure
Itching – the build-up of wastes in the blood can cause severe itching
Swelling in the hands and/or feet – failing kidneys don’t remove extra fluid, which builds up in the body
Shortness of breath – extra fluid can build up in the lungs, or anemia can cause shortness of breath
Pain in the small of the back – the pain is not made worse by movement
CKD Stage 1
Kidney damage with normal or increased GFR
GFR ≥ 90
Treat: Diagnose and treat other illnesses; reduce heart disease risk
CKD Stage 2
Kidney damage with mildly reduced GFR
GFR = 60 - 89
Treat: estimate the rate of CKD progression
CKD Stage 3
Moderately reduced GFR
GFR = 30 - 59
Assess and treat complications
CKD Stage 4
Severely reduced GFR
GFR = 15 - 29
Prepare for kidney replacement therapy
CKD Stage 5
Kidney Failure
GFR
Treatments
Anemia treatment – anemia (a shortage of red blood cells) starts very early in kidney failure and can make you very tired.
Medication – for example, blood pressure pills called ACE inhibitors or angiotensin receptor blockers (ARBs) can help protect kidney function.
Eating changes – some doctors believe a low protein diet can help slow kidney disease.
Avoiding certain pain pills – overuse of some over-the-counter pain pills with ibuprofen, naproxen, acetaminophen, or pain medications with caffeine in them can damage kidneys.
Regular blood pressure checks – high blood pressure can cause or speed up kidney failure.
Cut back or quit smoking – smoking tobacco can make kidney problems worse.
Uremia
When a person reaches ESRD, both kidneys have stopped or almost stopped and the body fills up with extra fluid and wastes that would normally be filtered out
Uremia Signs
Head – headaches, fatigue, and fuzzy thinking can be caused by uremia.
Mouth – food may taste bad or like metal, causing a loss of appetite.
Lungs – shortness of breath can be caused by a build-up of fluid in the lungs or by anemia.
Stomach – loss of appetite, nausea, and vomiting can occur if uremia is very severe.
Bladder – less (or no) urine may be produced. Some people still make urine, but it is mostly fluid—the wastes are not removed.
Hands – swelling can be caused by fluid build-up.
Feet – swelling can be caused by fluid build-up.
Skin – build-up of uremic wastes can cause severe itching.
Blood vessels – high blood pressure can occur, because the failing kidneys no longer keep blood pressure at normal levels.
ADA Glucose Test Recommendation
Annual glucose tests for:
- People with a family history of diabetes
- People who are obese
- Women who have delivered a baby weighing over 9 lbs.
- African-Americans, Hispanic Americans, Native Americans, Asian-Americans, and Pacific Islanders
How Dialysis Works
During dialysis, blood and dialysate are kept apart by a membrane (in PD, the peritoneal membrane has small blood vessels). Wastes and fluid flow out through tiny holes in the membrane. Blood cells and protein, which the body needs to keep, are too big to pass through, and stay in the blood.
Dialysate helps to pull the wastes out of the blood. Once dialysate is used, it is thrown away.
Peritoneal Dialysis
Uses your body (the peritoneum) instead of a machine
The peritoneum is a membrane that lines your abdominal cavity—it’s like a bag, holding your internal organs.
A PD catheter is placed in the lower abdomen, or less commonly, a “bathtub” or presternal catheter is placed in the chest
To do PD, this bag is filled up with a special fluid, called dialysate (dye-al’-i-sate). Wastes and extra fluid in the blood slowly flow into the dialysate. This is called a PD Exchange
Patients are trained to do it themselves at home
CAPD
Continuous Ambulatory Peritoneal Dialysis
Describes when people do PD exchanges by hand at home every few hours
3-5 exchanges per day; each takes ~30 min
Few food and fluid limits are needed; traveling is okay
Peritonitis
Infection associated with CAPD
CCPD (or Automated PD)
Continuous Cycling Peritoneal Dialysis
Uses a machine called a Cycler to do exchanges at night
Can be packed for travel or CAPD can be done while traveling
Medicare covers this immediately
PD Pros
Fewer limits on food and fluid
No ups and downs
You do the treatments yourself and decide the schedule
No needles; generally painless
Easier to travel
Gentle on the heart
PD Cons
Bloating; may need extra protein because of the sugar in the dialysate
Every exchange must be done carefully
Daily treatments
Catheter is permanently in your body
Works best for smaller people
Storing PD supplies takes space
Need precautions for some activities to avoid infection
Can cause weight gain
Hemodialysis (HD)
Uses special filter called Dialyzer - contains thousands of hollow fibers punctured with millions of tiny holes
Blood moves through inside of dialyzer fibers; blood cells and proteins are too big to pass through, so they go back to the body. Wastes and extra water go through holes and into dialysate fluid that is thrown away
Cleans 1 cup of blood outside the body at a time
Done 3x/week in a center for 3-4 hours each treatment; Longer is better
Only replaces about 10% - 15% of normal kidney function
Fistula Access
An artery and a vein are surgically linked to each other. Fistulas are usually placed in an arm. This is the best type of access because fistulas last longer and are less likely to clot or become infected
Graft Access
An artificial vein is used to surgically link an artery to a vein. Grafts can be placed in an arm or a leg.
Catheter Access
A Y-shaped plastic tube is placed into a large vein in the chest, neck, or groin. Because there is a high risk of infection, catheters are usually used only for temporary access.
HD Side Effects
Generally painless
if there is a lot of fluid to remove, painful cramping, headaches, faintness, nausea, shortness of breath, and other problems can occur
Salt and fluid limits are necessary
Some people want EMLA cream or liquid lidocaine to freeze the skin
In-Center HD Pros
Only 3x a week
Done by trained nurses and techs
Hours of personal time
Meet and spend time with other patients
Local anesthetics available
Usual activities okay
In-Center HD Cons
Very strict fluid limit and meal plan; treatment is time consuming
Centers are not necessarily comfortable
Treatment schedule may not fit your work schedule
Two needle sticks with large needles are used
Fistula or graft looks like a big, rope-like vein
Hard to travel spontaneously
Ups and downs depending on when the treatments are done
Toxins not removed on off days can build up over years and cause damage to nerves, joints and bones
In-Center Self Care HD
patients are trained to do as much of the treatment as they want to learn
Medicare starts right away instead of after three months
Home HD
Requires a partner to help
Doing longer and more frequent HD treatments can get rid of most symptoms
Medicare can start right away if home HD starts before the third month of dialysis
Center provides the machine, medicare pays
Done every other day since the two-day dialysis weekend can cause heart failure
Short, daily treatments = 5-7 times/week, 2+ hours per day
Nocturnal = at night for 8 hours, 3-6 nights per week
Medicare only pays for 3x per week so you need to appeal for more or get different health insurance
Benefits of Home HD
Fewer diet and fluid limits
With more HD, BP is more likely to be normal, so less likely to develop left ventricular hypertrophy
Blood chemistry levels are closer to normal, helping with problems like neuropathy, amyloidosis (build up of waxy protein in joints, tendons and bones) and bone disease
Kidney Transplant
Blood and tissue must match
Major surgery required
50% will have no further problems
35% will have some problems: new onset of diabetes, heart attack, complications, re-operation, hospitalization, rejection
15% will have major problems - die in the first year from heart attack, stroke, infection or other cause; some will return to dialysis; some will lose transplant function
Kidney Team
Nephrologist, RN, RD, and social worker with a masters degree (MSW)
Nurses
Licensed Practical Nurse (LPN) – completes a 2-year training program
Registered Nurse (RN) – completes a 2- or 4-year college degree and passes a special test
Certified Nephrology Nurse (CNN) – a registered nurse who also completes training focused on nephrology and passes a special test
Nurse Practitioner (NP) – completes special training for providing primary health care and passes a special test
Diet
Potassium does not get removed, so you must be careful with ingesting too much potassium because sudden heart failure can occur
Health Care Team B
Surgeon Home Dialysis Supplier Vocational Rehabilitation Counselor Physical Therapist Occupational Therapist Pharmacist
BP Medications
to prevent damage to your heart and blood vessels. Some blood pressure drugs (like ACE inhibitors and ARBs) also slow down some types of kidney disease. If you do peritoneal dialysis (PD) or daily or nocturnal hemodialysis (HD), most often at home, you may need fewer blood pressure pills, or you may not need them at all, since these treatments do a better job of controlling blood pressure than standard in-center HD treatments.
Cinacalcet
to help treat too-high levels of parathyroid hormone that can cause bone disease.
Erythropoietin stimulating agents (ESA)
injections to treat anemia (a shortage of red blood cells) by making more red blood cells. Treating anemia can give you more energy and help prevent heart damage.
People on dialysis get ESAs while they are treated, and they may have the drug injected into the dialysis tubing. ESAs are costly drugs, so some negotiation may be needed to get insurance to pay for them. For people who are on dialysis, ESAs are paid for by Medicare.
EPOGEN (Epoetin alfa, Amgen Inc.)
PROCRIT (Epoetin alfa, Ortho Biotech)
Aranesp (darbepoetin alfa, Amgen Inc.)
Reduce fatigue, increase appetite, improve endurance
Phosphate binders
antacids or special drugs taken to help your body get rid of extra phosphorus that can cause itching and long-term bone problems. If you do daily or nocturnal HD (most often at home), you may need fewer binders—or even no binders at all—since these treatments remove so much more phosphorus than standard in-center HD does.
Carnitine
to help build stronger muscles
Proteinuria
protein in the urine, measured with a dipstick test. Protein is usually too big to fit through nephrons, so protein in the urine indicates kidney damage
