renal Flashcards
disequilibrium syndrome
transient CNS disturbance after rapid decrease in ECF osmolality compared to ICF osmolality - post dialysis
Typical Hgb of ESRD:
6-8 g/dL
Less RBCs in ESRD because
- decreased EPO
- PTH replaces marrow with fibrous tissue
- shorter RBC life span
ESRD RBC will have increased
2-3 DPG
Oxygen-hgb dissociation curve in ESRD
shifted to the right, r/t 2-3 DPG that means oxygen is unloaded more quickly -> helps with chronic anemia.
Also chronically acidosis so also favors this.
prolonged bleeding in ESRD r/t to
decreased platelet factor III activity
defective von Willebrand factor
decreased adhesiveness and aggregation of platelets
anemia is almost present with CKD when
GFR <30 mL/min
unless they are on aggressive EPO therapy
Goal of EPO therapy
to keep HCT between 36 and 40%, avoid possibility of transfusion
increase CO in renal disease is to
compensate for decrease oxygen carrying capacity
Left ventricular hypertrophy
is common
uremic pericarditis can progress to
pericardial effusion and tamponade
chronic renal disease is a significant risk for
CV morbidity and mortality.
50% of deaths of patients with ESRD are CV in nature.
- HTN
- Anemia
- Hyperlipidemia
- atherosclerosis
- Calcification of valves - stenosis, regurgitation, or both
MV of patients with kidney disease
may be increased to compensate for chronic metabolic acidosis
pulmonary affects of renal disease
increased pulmonary extravascular water
- interstitial edema
- widened alveolar/arterial O2 gradient
- Butterfly wings on CXR
- hyperventilation, interstitial edema, alveolar edema, pleural effusion
abnormal lipid metabolism associated with renal disease
leads to accelerated atherosclerosis
percentage of patients with renal disease who develop GI hemorrhage
10-30%
renal disease is associated with hyper secretion of
gastric acid + delayed gastric emptying (from autonomic neuropathy) this leads to high risk for aspiration (RSI?)
drugs eliminated by kidneys unchanged are contraindicated:
phenobarbital, gallamine, LMWH
before lab tests are changed or impacted
> 50% of nephrons must be destroyed
BUN can be abnormal despite a normal GFR due to
hIgh protein diet
GI bleed
febrile illness
lag time r/t plasma creatinine
8-17 hrs lag time between change in GFR and related increase in serum creatinine
Creatinine Clearance Approximates GFR
Normal: Decreased Renal Reserve: Mild Renal Impairment Moderate Insufficiency Renal Failure: ESRD:
Creatinine Clearance Approximates GFR
Normal: 100 - 120 mL/min Decreased Renal Reserve: 60 - 100 mL/min Mild Renal Impairment: 40-60 mL/min Moderate Insufficiency: 25-40 mL/min Renal Failure: <25 mL/min ESRD: <10 mL/min
electrolyte abnormalities common with renal failure
Hyponatremia - usually dilution Hyperkalemia Metabolic Acidosis with high anion gap Hypermagnesemia - usually not an issue Hypocalcemia - increase PTH, calcification deposits Hypoalbuminemia - esp with dialysis Hyperglycemia - if insulin resistant
If renal patient remains hypotensive
check free calcium level, supplement as appropriate
