Renal Failure and Transplant

Question 1

2 major causes of renal failure

Answer 1

Dibetes Mellitus and HTN

Question 2

Reversible causes of renal failure

Answer 2

• Hypovolemia
• Infection
• Obstruction
• Exposure to drugs (Contrast or drugs that lower GFR)

Question 3

Definition of chronic kidney disease

Answer 3

GFR <60 or there is kidney damage manifested as proteinuria for greater than or equal to 3 months

Question 4

Signs symptoms of CKD

Answer 4

• HTN
• Proteinuria
• Edema
• Electrolyte abn
• Elevated BUN/ Creatinine
• Elevated PT/INR
• Fatigue, nausea, vomiting, pruritis, loss of appetite, amenorrhea, uremic smell, easy bruising or bleeding, muscle cramps

Question 5

Why do you start dialysis

Answer 5

• Hyperkalemia
• Fluid overload
• Pericardial effusion
• Acidosis
• Other electrolyte abnormalities
• Bleeding

Question 6

Explain renal osteodystrophy/mineral and bone disorders

Answer 6

• Increased retention of phosphorous, body secretes calcium, increased parathyroid hormone, or vitamin D.
• Abnormal bone turnover, mineralization, or linear growth.
• Phosphorous abnormalities start with GFR <40 but can be sooner.

Question 7

Treatment of renal osteodystrophy/mineral and bone disorders

Answer 7

• Restrict dietary source of phosphorous
• Prescribe phosphorous binders to be taken at meals
• Prescribe vitamin D supplementation which will decrease PTH levels
• Draw a PTH

Question 8

A common problem in renal failure is hyperkalemia. How would patient present and how to treat and dietary restrictions.

Answer 8

• May have weakness, fatigue, muscle paralysis, SOB, palpatations, chest pain, nausea, vomiting, parasthesias.
• Treat with dietary restrictions, drugs such as KAYEXALATE or with dialysis
• Dietary restrictions: Potassium < 40-70 mEq/day. <2.4 grams Na+/day.

Question 9

Nutritional needs in CKD

Answer 9

-Nutritional needs: Protein restrictions (0.6g/kg/day) and fluid restrictions? Restrict Na+, K+, Phosphorous. If malnourished…eat!

Question 10

Acidosis with CKD: What causes it and treatment

Answer 10

• Hydrogen ions are retained and renal failure making the patient metabolically acidotic.
• Treat by supplementing with sodium bicarbonate

Question 11

End Stage renal disease is fatal if not treated by:

Answer 11

Hemodialysis, peritoneal dialysis, renal transplantation

Question 12

A coronary heart disease risk equivalent is

Answer 12

Chronic kidney disease

Question 13

When can a patient be listed for a cadaveric kidney transplant

Answer 13

With a GFR of 20mL/min or less