Renal Health maintenance Flashcards
In renal failure pts preventive strategies usually focus on renal disease related issues of? Other general health issues?
- anemia
- mineral metabolism
- HTN
- vascular access for dialysis
- other general health issues:
vaccinations, cancer screening, control of DM, lipid management
What acute issues take priority over general health issues?
- infection
- bleeding
- malnutrition
- volume overload
- vascular thrombosis
- unstable BP
- with abnorm of immune fxn, pts with kidney disease are more susceptible to infection and malignancies
Preventive strategies include?
- infection screening
- immunizations
- lipid management
- DM control
- HTN management
- cancer screening
- smoking cessation
Who should be screened for kidney disease according to the National Kidney Foundation?
pts with:
diabetes
HTN
family hx of kidney disease
older than 60
ethinic minorities: african americans, native americans, asians
- recommended that minimal screening include assessment of GFR (serum creatinine included) and proteinuria
- Microalbuminuria is now an essential component
Who should be tested for urinary protein?
- as part of the initial assessment: new HTN, hematuria, or decreased GFR, DM
- as part of annual monitoring: bx proven GN, reflux nephropathy
- as part of routine monitoring for pts receiving nephrotoxic agents
What are the general signs you are looking for in a pt with suspected renal disease?
- blood in urine
- edema
- fatigue
Why is there such a high infection risk in renal pts? Where do this infections occur?
- renal failure pts have immune insufficiency
- hospitalization for infection are 3-4x worse in pts with CKD
- other risks: bacterial infection - lungs, intestines, peritoneum, urinary tract, and skin, infections secondary to skin excoriations from pruritus, xerosis, and atrophy of sweat glands
- common microorganisms are staph and E. coli
- klebseilla is not uncommon in pts with CKD who are hosp for pulm infections
Morbidity/mortality in renal failure pts because of infection?
- sepsis in ESRD has mortality that is 100-300 fold higher than general pop
- infective endocarditis can be fatal
- UTI’s in anuria pts: pyocystitis can lead to sepsis
- pulmonary infections: have 14-16 fold higher mortality rate
Screening and prophylaxis for bacterial infections in renal failure pts?
- examin skin
- placement of AV fistulas before initiation of hemodialysis
- screen for staph nasal colonization
- consider use of mupirocin or gentamicin ointment to catheter exits
- educate on dental evals
- endocarditis prophylaxis (2 g amoxicillin or 600 mg clindamycin) 1 hr before invasive dental procedures
What immunizations should renal failure pts have?
- influenza: decrease chance of hospitalizations
- pneumococcus: given to elderly and immunocompromised
revaccination 5 years after initial vaccination
can give titers every 2 years in ESRD when titers decrease below 200 micrograms/L - complication of arthrus-type reaction with frequency
- hep A (0, 1, 6 months)
- hep B (need surface Ag testing for HBV, and testing done before intiation of dialysis, seroconversion rates worsen as renal disease progresses, series of 3 injections 0,1-2, and 4-6 months
- hep C: not a vaccine, still good to screen, increase seroconversion with pts on dialysis
ESRD pts with Hep C must be tx before transplant d/t rejection
Why is lipid management so impt in renal disease? What should be checked and how often?
- risk of CVD is high
- fasting LDL, HDL, TG and total cholesterol levels should be checked once a year for pts with CKD
- should be set up with renal dietician
- meds: statins (simvastatin 20 mg qday)
Good glucose control?
- progression of CV complications with poor glycemic control
- HbA1C level should be controlled to belwo 7
- HbA1C should be checked every 6 months, unless change in tx, then every 3 months until goal is reached
- metformin should be avoided with creatinine above 1.5 in men nad 1.4 in women because of lactic acidosis
Blood pressure control?
- strict pressure control high priority
- ACEI or ARBs are commonly used as initial meds
- BP goal is less than 130/80, the NKF suggest BP be less than 125/75
- tight BP control can halt progression of renal failure
Why is tobacco cessation so impt? meds?
- cigarette smoking is assoc with more rapid decline in renal failure
- pt should be encouraged to stop cause of CV risk
- meds:
nicotine patch (21 mg, 14 mg, 7 mg), wellbutrin/bupropion, chantix (BBW: risk of suicide)
Cancer screening in renal failure pts?
- tumors of GU tract develop 4-5x more frequently than lung, colon, or breast
- RCC
- prostate cancer: 50 years and older with life expectancy of 10 yyears get annual DRE and PSA
- pts at high risk at 40 with DRE and PSA (only if on transplant list) get screened
- colorectal screening: colonoscopy at age 50 and repeat every 10 years if initial was negative, annual fecal occult blood test, flexible sigmoidoscopy every 5 years
- breast cancer: high risk pts whose life expectancy is 5 years
screening mammograms for women older than 50, and women older than 40 that are on the transplant list
both groups do SBEs - cervical cancer: high risk pts with life expectancy of 5 years or more, screening pap smears at age 21, HPV DNA testing and HPV vaccine in transplant pts, yearly pap test for those on transplant list
