Renal Flashcards
Meds with increased K+ levels
ACE inhibitors NSAIDS B blockers Bactrim Heparin Cyclospoine
Meds with decreased K+ levels
Loop diuretics Thiazides Insulin Antacids Laxatives
Causes of malnutrition in renal failure
- decreased nutrient intake
- loss of nutrients with dialysis
- increased catabolism
- metabolic acidosis
- frequent illness
- hypermetabolism (AKI)
AKI
Sudden decline in GFR
High risk for under nutrition
Accelerated loss of protein and AA —> loss lean body mass
Poor wound healing
Goals AKI
Preserve body protein stores
Maintain fluid balance, electrolyte, A/B
Prevent deficiencies
CKD
Gradual decrease in removal of waste products
Increase urea —> nausea, fatigue, loss of appetite
Decreased urine output
CKD stages
1-4 (predialysis)
5 (dialysis)
CKD I
> 90 GFR
CKD 2
GRF 60-89
CKD 3
30-50 GFR
CKD 4
15-29 GFR
CKD 5
<15 GFR
Goals or predialysis
Adequate calories Prevent uremia Restore biochemical balance Fluid balance/BP Glycemic control
P binders
Taken with meals to aid in elimination of excess P
Failure of Vit D activators
Decrease calcium
Increase P
Secondary hyperparathyroidism
Al binders
Short term use
Fe binders
Iron deficient
Predialysis vitamins
Folic acid
Vit D
Fe
No vit A
Dialysis goals
Protein equilibrium Acceptable ranges of K and Na Fluid homeostasis Ca, P and PTH levels Vitamins and minerals
P binders in dialysis
Important as dialysis doesn’t remove P well
Dialysis supplements
Iron (IV)
Folic acid
Vitamin D
Increase soluble vitamin removal (fat sol may be elevated)
IF you can’t do enteral in kidney failure what should you use?
TPN
PPN not able to meet needs
Renal transplant goals
- monitor cholesterol, BG, weight
- organ rejectionL prevent hyperkalemia, control BP
