The Uremic Syndrome and Principles of Dialysis Flashcards
What is decreased in CKD
Calcium
Why is calcium low in advanced renal failure
Decreased 1-alpoha hydroxylase…converts to active Vit D…decreased calcium absoprtion
Chemical precipitation/depoistion of Ca with high plasma phosphorous
Hormonal alterations in ARF
Increased phorphorus with decreased Vit D..
High phosphorus, low Vit D AND low Ca all leads to increased PTH
increased phosphorus also increased FGF23 which tries to get the kidney to get rid of phosphorus and suppress 1-alpha hydroxylase
Late renal failure Na K Ca PO4 HCO3 Creat BUN pH POSM
Dec Inc Dec Inc Dec INc INc Dec Inc
Why is sodium low
Pt retaining water and soidum…wants to drink more water
Why is bicarb low
H+ retaining AND the kidney is not making it
Malnutrition in advanced CKD
Low albumin, a sign of malnutrition is the most important predictor of mortality in dialysis patient
Albumin too large to be filtered by kidney
Excretion
Homeostasis
Endocrine
Metab
Endogenous and exogenous metabolits
Electrolytes, A-B, volume
Ednocrine - renin, EPO, calcitrol
Metabolism - catabolism of peptide hormones and gluconeogenesis
Definition of uremic toxins
Accumulate in with decreased kidney function
Small - easily dialyzed
MIddle or large - very difficult to dialyze
Some are small but protein bound and hence difficult to dialyze
Hypervolemic
High BP and edmea…differentiate from CHF
Both sodium and H2O retained so Na is low or normal
Uremic syndrome
General, vital signs, HEENT
Fatigue, slugglish like hypothyroidism…anemia and decreased basal metabolic rate
Vitals - HTN, hypervolemia (Na and H2O retention)…activation of renin-angiotensin-aldosterone system (RAAS)
Pallor, “ashy” color
Red eye - high phosphorus, CaxP product
Epistaxis - platelet dysfunction
Uremic syndrome pulmonary and cardiac sx
Pulmonary - dyspnea on exertion, exrterional anemica, hypervolemia, acidosis (kussmaul breathing…very deep)
Cardiac - hypervolemia…increased JVP, dilated LV, S3 gallop, edema
Pericarditis - pleuritc chest pain, better with sitting, pericardial rub
Arrhythmia - palpitation, syncope, high K, drug toxicity
GI
GU
Neurologic
Uremic syndrome
GI - uremic fetor breakdown of urea in saliva to amonia…poor apetite, N/V, malnutrition
GU- cannot concentrate the urine: polyuria/nocturia
Neuro - irrtability, somnolence, lethargy
Peripheral neuropahty - RLS, decreased sensation, decreased DTR
MSK and skin
Uremic syndrome
2ry hyperparathyroidism…high P, low calcitrol since 1-alpha hydroxylase reside in kdiney..low Ca, High FGF23
Soft tissue calcification - high CaxP
Calciphylaxis - skin necrosis
Bone pain, fracture, and decreased physical activity
Skin - prutitus - dry skin, high P and PTH
Easy bruisability due to platelet dysfunction
Bleeding in CKD
ARF…abnormal platelet glycoproteins…abnormal affinity to fibrinogen to VWF (7)…platelet dysfunction
