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36 Cards in this Set
- Front
- Back
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what are some major causes of CKD
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DM
HTN prolonged glomerulonephritis hereditary disease (polycystic kidney disease) |
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read about the pathophysiology of CKD
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read about the pathophysiology of CKD
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what are some things we can do to slow progression of CKD
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BP control (goal 130/80)
use ACE/ARB even if no HTN if CKD due to DM control glucose lipid mgmt/smoke cessation avoid DHP as monotherapy dietary protein restriction |
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what is the effect of NHDP (verapamil/diltiazem)
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cause dilation of efferent and afferent arteriole
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what is the effect of DHP
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cause dilation of afferent arteriole and increase pressure as well
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what are some things you may see with decrease kidney fxn
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volume overload
acid base imbalance electrolyte issues uremic bleeding pruritis anemia renal osteodystrophy |
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what occurs in volume overload
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decrease ability to excrete Na
signs/symptoms: HTN and Edema |
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how do you treat volume overload
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loop diuretics
TZD no good at CLcr < 30 |
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what occurs in acid base imbalance
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kidney not producing enough bicarbonate resulting in acid buildup
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how do you check to see if pt is acidodic
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check serum bicarbonate and CO levels
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how do you treat the pt if they're acidodic
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give them bicarbonate but must be careful since pt still has decreased renal function
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what can worsen hyperkalemia
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metabolic acidosis
drugs (ARB/ACE Beta blockers) |
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how do you treat hyperkalemia
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calcium gluconate/chloride
sodium bicarbonate insulin albuterol SODIUM POLYSTYRENE (only thing that actually removes K) |
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what are the effects of Vit D
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decrease urinary Ca excretion
reabsorbs Ca and PO4/Mg inhibits PTH synthesis when have adequate Ca levels |
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how does CKD effect someone's Vit D levels
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Vit D is activated by both the liver and kidney
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what is the effect of PTH
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decrease urinary Ca excretion
increase urinary PO4 excretion mobilize Ca from bone increase activation of Vit D3 |
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how does renal osteodystrophy occur
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decrase Kidney fxn
decrease Vit D activation decrease Ca lvl b/c not reabsorbing as much hypocalcemia increase PTH therefore take Ca from bone renal osteodystrophy |
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what are the causes of hyperphosphatemia
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decrease PO4 excretion
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how do you diagnose someone as being hyperphosphatemic
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Ca * PO4 < 55
if greater than 55 need to decrease PO4 |
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how do you treat hyperphosphatemia
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dietary restriction (dairy, beans, beer, cola)
phsophate binders: calcium (calcium acetate/calcium carbonate), aluminum (alternagel), polymer based (sevelamer -renegal) lanthanum carbonate |
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what causes hypercalcemia and hypocalcemia
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hypercalcemia - hyperparathyroidism, phosphate binders
hypocalcemia - hyperphosphatemia, decrease Vit D3 synthesis |
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what causes hyperparathyroidism
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decrease Vit D synthesis
decrease serum Ca |
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how does CKD pt get Anemia
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decrease EPO secretion
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what are symptoms of anemia
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fatigue
decrease excercise capacity left ventricular hypertrophy |
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when treating someone with anemia what is your Hbg goal
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b/t 10-11 no more than 11
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what is a SE of EPO
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hypertension, HA, pain at injection site
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what is a major cause of death for people w/ CKD
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cardiovascular disease
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how do you manage cardiovascular disease
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treat lipids and BP aggressively
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what is the LDL goal of hyperlipidemic patients
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LDL < 100
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what are signs of Pruritis
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dry skin
CaPO4 buildup histamine release |
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how do you tx Pruritis
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antihistamine
phosphate binder cholestyramine UV light |
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a GFR value less that what indicates CKD
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<60 for 3+ months
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what GFR is stage 4 CKD
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15-29
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when would you use the corrected Ca equation
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when albumin is less than 4 and calcium is low
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how do you treat uremic bleeding
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DDAVP
conjugated estrogens EPO dialysis |
