Nephrology: End-Stage Renal Disease / Dialysis

Question 1

End-Stage Renal Disease

Answer 1

Uremia progressed so much you need dialysis

what will kill you but you cannot correct without dialysis? (acidosis, persistent hyperkalemia, pericarditis)

Question 2

Most common reasons to go on dialysis

Answer 2

diabetes and hypertension

other causes: glomerulonephritis, cystic disease, interstitial nephritis (all about 15%)

decreasing hypertension and controlling diabetes will decrease progression of uremia

Question 3

dialysis for:

Answer 3

fluid overload

severe acidosis (1 meq acid made per day)

buffering does’t work:
ammonia to ammonium
phosphate to phosphoric acid

pericarditis - die from arrythmias and tamponade

encephalopathy - (die from accidents)

severe hyperkalemia - persistent

Question 4

hemodialysis vs. peritoneal

Answer 4

equal in efficacy

peritoneal more prevalent in Europe

peritoneal has more complications - peritonitis with staph aureus (put antibiotics straight into tube)

Question 5

complications of ERD

Answer 5

• these don’t need dialysis

anemia - give erythropoeitin

hypocalcemia - 1,25 dihydroxy vitamine D not made which leads to decreased GI absorption of Ca (1 is made in kidney)

• causes increased PTH which depletes calcium in bones, and also causes phosphates to be released
• have to give phosphate binders (savelamar - non-calcium containing phosphate binder)
• synicalate is a calcimimetic, causes decreases PTH release
• aluminum based phosphate binders causes dementia, don’t use them

-echinocytes are spiculed red blood cells seen on smear in ESRD

magnesium builds up, change diet

accelerates athersclerosis, number one cause of death in ESRD is MI and coronary disease

• lower the blood pressure 130 / 80

increased infections, white cells don’t degranulate - no therapy other than dialysis

increased superficial bleeding because platelets don’t degranulate - give desmopresin (DDAVP) causes release of VWF and factor 8 from sub endothelium, platelets become sticky