Renal Disease Part 2 Flashcards
1
Q
Chronic Kidney disease is also called ______
A
chronic renal failure (CRF)
2
Q
Chronic kidney disease is defines as either ______ or ____________
A
kidney damage or GFR <60 ml/min/1.73m2 for ≥ 3 months
3
Q
chronic kidney disease is a _______ in kidney function over time
If detected early, medication and dietary changes may ______
A
gradual decline
slow the progression
4
Q
what is the best measure of kidney function
A
GFR
5
Q
GFR is used to categorize a patient regarding the _____ of chronic kidney disease
A
stage
6
Q
GFR is calculated by MD using the patient’s serum ________ level, age, race, body size, and gender
A
creatine (Cr)
7
Q
expert in kidney disease
A
nephrologist
8
Q
Stage one description and GFR
A
possible kidney damage with normal GFR
≥90
9
Q
stage two description with GFR
A
kidney damage with mild decrease in GFR
60-89
10
Q
stage three description and GFR
A
moderate decrease in GFR (problems occur)
15-29
11
Q
stage four description and GFR
A
severe decrease in GFR (make plan for dialysis or transplant)
15-29
12
Q
stage 5 description and GFR
A
kidney failure, end stage renal disease (ESRD)
<15 or on dialysis
13
Q
oliguria ?
A
inadequate urine output
100 - <500 ml/d of urine output
14
Q
anuria ?
A
complete cessation of urine flow
0 - <100 ml/d of urine output
15
Q
Some causes of Chronic Kidney Disease
- _______
- _______
- glomerulonephritis
- polycystic kidney disease
- systematic lupus erythematous (SLE)
- repeated UTIs
- nephrotic syndrome
A
DM
HTN
16
Q
signs and symptoms of CKD
A
azotemia
uremia
17
Q
the accumulation of abnormal quantities of nitrogenous wastes in the blood
what are these wastes?
A
azotemia
BUN
18
Q
physical signs and symptoms related to azotemia
A
uremia
19
Q
uremia symptoms
A
malaise (tired)
weakness
N/V
muscle cramps
pruritus (itching)
dysgeusia
neurological impairment
20
Q
normal glomerular filtration rate (GFR)
A
90-120 ml/min/1.73 m2
21
Q
in CKD, serum _____ levels and ______ levels can INCREASE
A
creatine
BUN
22
Q
normal creatine
A
0.5-1.1 mg/dL for women
0.6 - 1.2 mg/dL for men
23
Q
daily production of creatine depends on ______
A
muscle mass
24
Q
Medical Treatment for CKD
A
treat/manage underlying causes
Dialysis
transplantation
25
types of dyalisis
hemodialysis (more common in US)
peritoneal dialysis
26
Hemodialysis (HD) removes ____ and _____ from the body
usually requires ___ sessions a week for ____ hours each
waste
excess fluid
3
3-5
27
In Hemodialysis, ______ passes through a _______ membrane to be filtered
- _____ products are removed thru _____
- water removal is called __________ and is done with pumps that are connected to the dialysis machine
blood
semipermeable
waste
diffusion
Ultrafiltration
28
a collection of thousands of hollow plastic fibers inside a plastic cylinder
dialyzer
29
types of vascular access
fistula
graft
catheter
30
Arteriovenous (AV) fistula is made by ?
How?
sewing together an artery and a vein in the forearm to make the vein stronger and larger
2 needles inserted into the fistula (one for withdrawing bool and one for returning blood)
31
why get a arteriovenous fistula
to make a vein that is strong and large enough for routine dialysis
takes a couple months for it to be ready to use
32
preferred/reccomended access for long term HD
Why
AV fistula
less prone to infections and blood clots
veins and arteries self-heal after each needle stick, so fistulas can last a long time
33
Arteriovenous Graft is a ?
piece of tubing that is used to surgically attach an artery and a vein
34
arteriovenous graft is more likely to have difficulty with _____ because it is made out of synthetic material.
develop _____ because the material cannot _____ after needle punctures
blood clots
holes
self-heal
35
most common HD access ?
why?
arteriovenous graft
ready a couple weeks after placements
36
catheters would be placed in the ____ or ____ and inserted into a _______ vein
neck or chest
central
37
catheters used for ?
short term temporary time sensitive access
38
advantage of catheter
disadvantage of catheters
can be used the same day
most prone to infection
can be accidentally pulled out
39
advantages of HD compared to peritoneal
patient involvement is minimal
treatment is controlled by trained staff
40
disadvantages of HD
time consuming
loss of protein (up to 15g per treatment)
fluctuations in serum levels of urea, K, Phos, and Fluid
41
complications of hemodialysis
hypotension
infections at access site
graft failure
42
what is peritoneal dialysis (PD)
Dialysis that uses the semipermeable membrane of the peritoneum as the dialyzer
43
PD works by infusing _____ into the ______ through a surgically placed catheter in order to create a concentration gradient.
waste products and electrolytes pass from the ______ through the peritoneal membrane into the _______ via ______
water passes via _____
dialysate is then drained form the peritoneal cavity
high dextrose dialysate
peritoneal cavity
blood
dialysate
diffusion
osmosis
44
PD Dialysate bags hold ___, ____, and ___ liters of solution
the strength can vary from ___, ____, or _____ percent
1.5
2.0
2.5
1.5%
2.5%
4.25% (if large amount of water needs removed)
45
Types of PD
1. _______ AKA ________
2. ________________
Automated Peritoneal Dialysis (APD)
continuous cyclic peritoneal dialysis (CCPD)
Continuous Ambulatory Peritoneal Dialysis (CAPD)
46
Automated Peritoneal Dialysis (APD)
aka - continuous cyclic peritoneal dialysis (CCPD)
Uses a _________ for installation &
drainage of the dialysis solution
usually done _____
machine (cycler)
overnight
47
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Performed using __________
gravity-based technology
48
Steps for Performing CAPD
1. Fill: Dialysate enters the peritoneal cavity (bag hung)
2. While fluid dwells in the peritoneal cavity, extra fluid
and wastes are drawn out of the blood and into the
dialysis fluid.
3. Drain: After ~4-6 hours the dialysis fluid is drained-called and replaced by fresh fluid.
49
Advantages of PD
Dialysis is done _____
__________ in serum levels of urea, K+, & fluid
________ treatment
More ______ diet
May contribute to a more ______ lifestyle (especially if using ____)
daily
Less fluctuations
Home-based
liberal
flexible
APD
50
Disadvantages of PD
Protein losses of_____ g/day
_______ can be absorbed from the dialysate and contribute on average ______ kcal/day
Weight _____
Poorly controlled ____
Complication=> ________
20-30
Dextrose
400-800
gain
DM
peritonitis
51
Evaluating the Adequacy of Dialysis
Studies have shown that patients who are not adequately dialyzed have an increased risk of _____________
morbidity & mortality
52
Complications of CKD
Alterations in fluid volume=>________
Electrolyte abnormalities: ________
_____
Metabolic _______
Secondary _____________
Glucose _________
hypervolemia
Na, K+, & Phos
HTN
acidosis
hyperparathyroidism
intolerance
53
Measurement of reduction of urea that occurs during a dialysis treatment is __________
To calculate: _____________
Well-dialyzed if there is a reduction in urea by >_____
Urea Reduction Ratio (URR)
(predialysis BUN – postdialysis BUN) / predialysis BUN
65%
54
Anemia from CKD
__________________ anemia
caused by:
Inability to produce __________
Increased ___________ due to circulating ___________
Normochromic, normocytic
erythropoietin
destruction of RBCs
uremic waste products
55
Signs/symptoms of CKD anemia:
Decreased serum _________
____________________
Hgb & Hct
Fatigue, pallor, lightheadedness, SOB
56
IV iron can come in different forms... including _______, ________, and _______.
iron dextran (Infed)
iron gluconate (Ferrlecit)
Iron Sucrose (Venofer)
57
goal is to have serum ferritin be ______ ng/mL but _____ ng/mL for HD patients receiving EPO
>300
<800
58
Human Recombinant Erythropoietin=> Epogen (EPO) has a food drug interaction that ___________
Solution?
increases need for iron for production of RBC
IV iron
iron stores measured monthly (look at serum ferritin)
59
Renal Osteodystrophy signs and symptoms
Bone pain
pathologic fractures (break under little stress)
metastatic calcifications
60
Renal Osteodystrophy
Pathophysiology=> As renal function declines:
Kidneys cannot excrete ____ load=> _______
Serum ____ levels decline due to:
Decrease in ______=> decreases intestinal absorption of ___
Phos
hyperphosphatemia
calcium
1,25 dihydroxyvitamin D3
Ca
61
Renal Osteodystrophy
Low serum Ca levels trigger release of ____________ leading to ____________
Increase in calcium phosphorus product=> leads to ____________
Parathyroid Hormone (PTH)
bone resorption of Ca
calcifications of soft tissues
62
____________________ = calcifications
National Kidney Foundation (NKF) goal: _______
serum Ca x serum Phos > 70 mg2/dL2
Keep Ca x Phos product < 55 mg2/dL2
63
MNT for Renal Osteodystrophy
For the calcium, adjust total intake from _____, ________, & ________ to avoid ________
______ supplements (__________)
_________ supplementation (_______)
food
supplements
Ca-based Phos binders
hypercalcemia
Calcium (Calcium carbonate)
Active vitamin D (Rocaltrol)
64
Calcium supplements should be given ___________ (when?)
on an empty stomach
between meals
at bedtime
65
MNT for Renal Osteodystrophy
For the Phosphorus=>______________
_____________ medications:
MOA=> bind phos in the gut
Calcium-containing binders
Calcium Acetate (PhosLo), Calcium Carbonate (Oscal)
Complication=> hypercalcemia
Sevelamer hydrochloride (Renagel)=> lowers Phos
without increasing Ca
Ferric citrate=> iron-based binder
Take phosphate binders with meals
Decrease dietary phosphorus intake to <1000 mg/d
Phosphate-binding
66
Phosphate-binding medication contain _____________ and _____________
MOA which binds phos in the gut
Calcium-containing binders
67
calcium containing binders include
calcium acetate (PhosLo)
calcium carbonate (Oscal)
Sevelamer hydrochloride (Renagel)
68
Complication with calcium containing binders
hypercalcemia
69
Sevelamer hydrochloride (Renagel) does ?
Example of iron based binder ?
Take phosphate binders at what time?
lowers phos without increasing Ca
Ferric citrate
with meals
70
High prevalence of _____ in patients on long-term dialysis secondary to ____
Also caused by Accelerated __________
CVD
HTN
atherosclerosis
71
Non-traditional risk factors for CKD CVD:
___________
____________
____________
MNT: ________________
inflammation & oxidative stress
abnormalities of lipoprotein metabolism
vascular calcifications
Mediterranean diet pattern may improve
lipid profiles
72
Other Complications of CKD
Increased ____________ tendency
Impaired ________ function=> Increased susceptibility to infections
bleeding
leukocyte
73
Neurologic manifestations of CKD CVD=>
insomnia
difficulty concentrating
peripheral neuropathy
restless leg syndrome
seizures
encephalopathy
74
MNT for CVD CKD
Mediterranean diet pattern to improve lipid profiles
75
One of the most common complications of CKD –
especially for those on dialysis
Malnutrition
76
Factors Leading to ______
N/V
Taste alterations
Anorexia
Fatigue
Multiple dietary restrictions
Inadequate intake due to depression, missed meals due to dialysis, food insecurity, inability to obtain or prepare food
Malnutrition
77
Factors Leading to Malnutrition
__________ interactions
___________ from dialysis treatments
Inflammatory response=> __________ requirements
Food-drug
Protein loss
increases protein
