Monica - Week 13 - Exam 4 Flashcards
Review: what are the 5 parts of the nephron?
- glomerulus (bowman’s capsule)
- proximal convoluted tubule
- loop of henle
- distal convoluted tubule
- collecting duct
what are the three main functions of the kidneys?
- regulatory
- excretory
- endocrine
what are the main characteristics of the regulatory functions?
- regulates blood pressure via RAAS
- maintains fluid and electrolyte balance through RAAS and anti-diuretic hormone
- regulates acid-base balance excretes acid load and makes bicarb. to ensure 7.4 pH
what is the one excretory characteristic?
excretes waste products (filters out metabolic waste, excess ions, and water)
what are the three hormones made by the kidneys? what do they do?
- erythropoetin (stimulates bone marrow → RBCs → ↑ hgb)
- renin (helps regulate BP through RAAS)
- calcitriol (active Vitamin D - absorption of calcium via GI; holds calcium in the kidneys and excretes phosphorus)
what stimulates the secretion of erythropoetin?
↓ O2 supply
what stimulates the RAAS system?
↓ blood volume, hemorrhage, dehydration
CKD is an _______, _________ disease.
irreversible, progressive
CKD develops over __________- to __________
months, years
people with CKD are unable to: (3)
- excrete waste products
- respond to acid-base imbalance
- control blood pressure and fluid volume
T/F: CKD progresses to end stage renal disease
TRUE; 90 - 95% of nephrons are effected
what are the 3 non-modifiable risk factors for CKD?
- family hx of kidney disease, DM, HTN, CVD
- age > 60 (as we age, kidney function ↓)
- ethnicity (African Americans and Hispanics)
African Americans - ____ times ↑ incidence of CKD - Incidence and complications r/t ____
Hispanics ____times higher incidence of CKD
2.7; HTN; 1.5
what are the two modifiable risk factors for CKD?
HTN and DM
what are three reasons HTN is a risk factor?
- cause and consequence
- kidney arteries narrow, weaken, and harden
- gradual deterioration of glomerulus (not able to filter as well - non-reversible)
what are 4 reasons DM is a risk factor?
- damage to glomerular capillaries
- ↑ permeability of proteins → diabetic nephropathy
- Small amounts of protein → microalbuminuria
- Larger amounts of protein → proteinuria
- *proteinuria on at least 2 occasions 3-6 mos. apart
DM is the ____ _____ of CKD
leading cause
what is the treatment for DM and HTN? Why?
ACE Inhibitors and ARBs (angiotension receptor blockers)
because they are ~renoprotective~
what are the names of the three lab data related to CKD?
BUN, Creatinine, and Glomerular filtration rate (GFR)
what is BUN?
- urea nitrogen in blood
- made when protein broken down by liver. excreted by kidneys (not specific to kidney)
- used w/ Cr and GFR for kidney disease process
BUN is used to assess _____ and ______ function
kidney AND liver
what is creatinine?
- waste product of muscle metabolism
creatinine is specific to ____________ function
KIDNEY
what is AKI?
acute kidney injury; sudden injury to kidney caused by dehydration, infection (shock)
what is the glomerulus and what is GFR?
- glomerulus - semi-permeable membrane
- GFR - amt of blood filtered per minute
glomerulus has the ability to _____ ______.
filter wastes; 90-120mL/min
what occurs when kidney disease progresses?
GFR ↓
what is the best indicator of kidney function?
GFR!
T/F: African Americans have higher GFR than other races d/t ↑ muscle mass
TRUE
how many stages are there of kidney disease?
5 stages
what are the characteristics of stage 1?
kidney damage w/ normal or ↑ GFR; GFR > 90; diagnosis/tx; asymptomatic
what are the characteristics of stage 2?
kidney damage with mildly ↓ GFR; GFR 60 - 89; estimating progression; asymptomatic
what are the characteristics of stage 3?
moderately ↓ GFR; GFR 30 - 59; evaluating and tx of complications; clinical and lab complications of CKD
what are the characteristics of stage 4?
severely ↓ GFR; GFR 15 - 39; prep for kidney replacement; dialysis, kidney transplant; clinical and lab complications of CKD
what are the characteristics of stage 5?
kidney failure; GFR <15; replacement; uremic symptoms become prominent and need to accept replacement tx
what is creatinine clearance?
- total amt of creatinine in urine
what does ↓ creatinine clearance mean?
↓ GFR and impaired renal function
**evaluate kidney function
what does 24 hr urine collection do?
- creatinine, proteins, and electrolytes excreted over a 24hr period
- captures maximal excretion of substance
what are the 5 characteristics of the collection process for 24hr urine?
- keep container in ice
- note start time on container
- discard first void
- end time 24-hr from start time
- must restart if any void is
discarded during 24-hr period
what are the 8 clinical manifestations of CKD?
mineral disorder hyperparathyroidism hyperphosphatemia hypertension proteinuria & diapetic nephropathy peripheral edema anemia of chronic disease metabolic acidosis & hyperkalemia
what occurs in mineral disorder?
- Less vitamin D converted to calcitriol
- Can’t absorb calcium → hypocalcemia → muscle twitching and osteoporosis
- Calcitriol and hypocalcemia deficiency (PTH release → bone breakdown)
what is the treatment for mineral disorder?
calcitriol and calcium supplements
what occurs in hyperparathyroidism?
- parathyroid gland secrets more PTH (kidneys rid phosphorus; retain Cal+; GI retains Cal+)
- Bone resorption → ↑ risk of bone fractures
what occurs in hyperphosphatemia? what is the treatment?
- ↓ phosphate excretion
- Tx: phosphate binders PhosLo (contains cal+) and sevelamer
- ↓ phosphate foods intake (dairy, nuts, meat, fish, poultry, beans)
what occurs in HTN? what is the treatment?
• renin release via RAAS (not enough perfusion → aldosterone release → Na+, H2O retention
what occurs in proteinuria & diabetic nephropathy?
- glomerular permeability ↑
- protein in urine
- loss of colloidal osmotic pressure → edema and third spacing
what occurs in peripheral edema?
• hypervolemia and inadequate filtration
what occurs in anemia of chronic disease?
- erythropoietin production deficiency
- bone marrow makes fewer red blood cells
- normocytic and normochromic anemia
- lower Hgb and Hct
what is the tx for anemia of chronic disease?
erythropoietin stimulating agents and iron supplements
what occurs in metabolic acidosis and hyperkalemia?
• impaired ability to excrete acid load
• defective reabsorption and making of more HCO3
• shift of H+ into the cells and K+ out of the cell
→ hyperkalemia
• Hyperkalemia d/t impaired kidney excretion
• K+ foods, supplements, drug
what is pharmacologic intervention for hyperkalemia?
sodium polysterene sulfonate
what is the indication for sodium polysterene sulfonate ?
mild to moderate hyperkalemia
what does Na+ polysterene sulfonate do?
- exchanges Na+ for K+ ions in the intestine
- eliminated in feces
when is Na+ polysterene sulfonate contraindicated?
abnormal bowel function or history of bowel disorders
what forms does Na+ polysterene sulfonate come in?
PO and retention enema
what is the expected outcome for Na+ polysterene sulfonate?
normalized serum K+ levels
8 Collaborative Care & Lifestyle Modifications
- Managing HTN ( ACE-I and ARBs)
- Diet: Low Na+, K+ Monitoring, Protein Intake (protein hard on kidneys),
+ Phosphorus Restrictions - Lowering cholesterol (statins)
- Achieving optimal glycemic control (7% or less A1C)
- Exercise routine (↑ insulin sensitivity)
- Limiting or avoiding exposure to nephrotoxic drugs (antibiotics)
- Avoiding alcohol (causes kidney to filter less)
- Smoking cessation (vasoconstriction → ↑ BP)
