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49 Cards in this Set
- Front
- Back
aka for Chronic Renal Failure (CRF)?
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Chronic Kidney Disease (CKD) is preffered/new
-also End Stage Renal Disease |
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Define Chronic Kidney Disease,CKD?
What is Uremia? |
Long-standing, IRREVERSIBLE impairment of Renal Function
Uremia: Clinical Syndrome Resulting from Profound loss of Renal Function--ie will have Azotemia (high BUN lab) plus systemic symptoms |
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What is used to measure GFR?
2 ways |
Inulin--but lab needs to be setup for it. and have it to give IV
whereas Creatine Clearance: 24 hour Urine Sample measured and related to Serum Creatinine -- |
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What is MDRD
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Modified Dietary approach to Renal Disease
--use to correct GFR ---special formula, dont worry about it unless given |
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What is KDOQI
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Kidney Disease Outcomes Quality Initiative
--way to get MDRD or |
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What is Cockcroft-Gault Eqn?
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Used for GFR, not as accurate as MDRD
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What are the 5 stages of CKD?
give associated GFRs |
1. Kidney Damage with NOrmal or Inc. GFR: >90
2. Mild Dec in GFR: 60-90 3. Moderate Dec in GFR: 30-59 4. Severe Dec in GFR: 15-29 5. Kidney Failure--aka ESRD --<15 GFR or on Dialysis Have to know these |
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What is Name and GFR of Stage 3 CKD?
memory Trick? |
3 for 30
Stage 3/Moderate has miimum GFR of 30 3. Moderate Dec in GFR: 30-59 |
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What is name and GFR for Stage 2 CKD?
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Stage 2: Mild: 60-89
just parameters of Stage 3 (low is 30) and add 30 (29 really) |
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What is Stage 1 CKD?
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Kidney Damage with Normal or Increased GFR >/= 90
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What is Stage 4 CKD?
Memory trick? |
Stage 4: Severe Decrease
15-29 Know that 4 is just before ESRD, which is GFR less than 15 |
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What is Stage 5 CKD
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Kidney failure
aka ESRD <15 GFR OR on Dialysis |
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What is worry in Early stage CKD, ie if symptom free/overall fxn intact?
NOTE: for at least next 10 flash cards, Kirilas slides/explanations fucking blew. Also her slides and speech confused Azotemia and Uremia as if interchangeable, but did not say where its correct/incorrect |
Reserve Functionis diminished
--ie a small assualt can throw into failure ----so just read these next 10 guys, perhaps even think about them. but thats all. You're number 1! dave kramer is gay |
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Case 1: 58y/o Female, Hx of Sarcoidosis, intermittant HTN, Elevated Blood sugars when on Steroids for sarcoid
-eGFR: 80 = stage? -ACE-I to protect kidney -Azotemia -Dec Reserve--sudden stress, ie UTI could trigger failure |
Stage 2 CKD: 60-89
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What is the effect of the following?
Inc. ICF Na+ Dec ICF K+ Ibx of Ca+ flux? |
Reduction of Transmembrane Voltage
--ie, here these are Uremic Toxins ---Note: Uremia and its effects are largelu reversible with dailysis |
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Name some common effects of Uremic Toxins on Whole body Composition
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Osmotically Induced Overhydration of Cells
--Inc 3rd Spacing--aka inc EC Volume --Malaise, Anorexia, N/V/D ----Pr & Calorie Malnutrition ----Neg Nitrogen balance ---Profound loss of Lean body mass and fat deposits --shitty slide just read this |
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Unusual Effects of Uremic Toxins on Metabolism include?
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Hypothermia: dec in active Na transport
-ICF K+ deficits -Metabolic Acidosis |
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What are Uremic Toxins' effects on nitrogen and Lipids
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Protein intolerance
--inc catabolism in uremia --dec elimination HyperTG-emia, dec HDL, Normal Cholesterol --dec removal by LipoPr Lipase --inc lipogenesis (plus lose lean mm mass) --may have inc. production of LDLs |
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Effects of Uremic Toxins on Na and Volume Homeostasis
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Total Body content of Na and Water are increased modestly --in stable CKD
-Excessive Salt Ingestion can lead to : CHF, HTN, Ascites, Edema |
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What might be restricted from diet before dialysis?
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Protein Restriction
---due to Nitrogen/protein intolerance --results from inc catabolism in uremia |
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What is fluid intake for pre-dialysis?
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Urine Output plus 500ml/Day
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Describe the K+ effects in CKD?
When goes bad, what happens? |
Normal until Late Stages
Inc. K+ = Cardiac Arrys |
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What are some drugs that cause Increase in K -- aka
AntiKliuretic Drugs? |
Spironolactone
Tramterene Amiloride TMP Pentamidine ACEs Beta Blockers NOte: Spironolactone--diuretic also used as anti-androgen |
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What are some extrerenal fluid loss mechanisms
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GI Syndrome
Vomiting, Diarrhea, Fever, --cause volume depletion ---result in Dry Mucous mems, dizziness, syncope, Tachy, dec. JVP, Orthostasis, CV Collapse |
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What is most complication of ESRD?
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HTN as a result of Primary Renal Dz or effects of Kidney from Systemic Dz
-Chronic Dialysis Pts also have a higher incidence of Accelerated Atherosclerosis which contributes to the HTN |
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What if Pt is ESRD and does NOT have HTN
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Consider:
Salt Wasting Form of renal Dz volume depletion Or ON Anti-HTN Meds at time |
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Commonest Pulmonary complication of CKD?
X ray feature |
Pulmonary Congestion (can have even in absence of volume overload--unique)
--due to Normal or mildly elevated Intracardiac or Pulmonary Wedge Pressures -CXR: Butterfly Wing distribution--peripheral vascular congestion --due to increased permeability of alveolar caps |
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What is another heat condtion assc/ CKD?
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any Itis
ie, Pericarditis Pleuritis --less frequent in early dialysis ---think viral if present while on dialysis |
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Associated Conditions, hematologic?
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Normocyte, normochromic anemia
-hemolysis--can be in uremic pts occasionally hypersplenism |
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How might the be immune compromised?
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Focus on fact just that they are
but reasons can be --Lymphocytopenia --atrophy of lymphoid strs --Uremia impairs fxn of all leukocytes |
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Specific disease to bone with uremia?
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Most common Osteopenia and Osteomalacia , but
Renal Rickets --widened osteod seams at growth margins plus --Osteitis Fibrosis cystica--2nd to Hyperparathyroidism (bone resorption) --Osteosclerosis |
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What compounds must certainly be avoided in long term dialysis with regard bone problems?
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Aluminum and Magnesium containing compounds
--can buildup and lead to bone problem ---not cleared in pre-dialysis pts --Mg in Many Antacids note: dialysis can cause amyloidosis |
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Case #3: 42y/o Fem. inc fatigue, dyspnea, poor appetite, BP rising, Lipids and swelling of extremities.
Labs: RBC casts, inc K, Low Albumin and eGFR = 20 (=stage 4, severe (15-29)) Proteinuria FHx with kidney probs + diabetics in fam Diagnosis? |
Idiopathic Nephrotic Syndrome
-not pt is not diabetic, no prior HTN |
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Case continued:
Biopsy showed FSGS which compromises 15% of Nephrotic Syndromes ---this progresses and is difficult to reverse What is Tx? |
NO proven tx,
Steroids +/- cytotoxic agents can be tried --Start Dialysis |
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List Indications of Dialysis?
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Unresponsive to Conserv Mesures
-Volume overload refract to diuretics -Hyperkalemia -Encephalopathy otherwise unexplained -Pericarditis, Pleuritis...itises -Severe Metabolic Acidosis compromising Resp or Circulatory Fxn -Need for Fluids/Drugs also a consideration?? |
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What are 2 sorts of Dialysis?
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Hemodialysis or Peritoneal Dialysis
Hemodialysis--uses A/V Fistula |
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Complications from Peritoneal Dialysis?
fluids drained and reput in peritoneum |
Peritonitis
Hyperglycemia HyperTG-emia Obesity HypoPr-emia Dialysis related Amyloidosis -Insuf Cl due to vascular dz, etc DONT worry about all these |
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Name a few unique Physical Exam findings on these patients?
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JVD
Pericardial friction rub -Mm wasting -Asterixis---hands flow -Exocoriations & Ecchymoses --Urochrome on skin--ITCHY |
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What are the Labs that are usually high in ESRD?
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Potassium
Phosphate Uric Acid |
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What are the labs most often low in ESRD
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Calcium
Albumin (serume0 Hemoglobin pH will be low too |
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What are some conservative Tx for ESRD?
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Aggresive HTN meds
Diuretics, VOlume Restrictions EPO--recombinant -Restrict Protein note: at certain point diuretics wont work |
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What are some conservative Tx for ESRD regarding GI syndromes?
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Bicarb
--helps with acidosis, and helps bind Phosphate, which is often high |
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What med binds K+ to lower ?
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Kayexalate
-sodium polystyrene sulfonate or just restrict potassium |
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What are 2 potassium Wasting
ie NON Antikalemuretics |
Lasix or Furosamide
--albutoral inhaled can lower potassium w/o changing fluid status |
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What are the 2 methods (timing) for Dialysis?
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PD: peritoneal dialysis, cycler
IHD: intermittent--most used for ARF, CKD wil get 3x perwk -Night time dialysis= home dialysis |
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What is CRRT
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Continuous Renal Replacement Therapy
--used if intolerant to IHD --or in extremely unstable ICU pts |
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not emphasized, but
Complications of Hemodialysis? |
Hypotension
Accelerated Vasc Dz Rapid Loss of Residual Renal Fxn Access Thrombosis Access Catheter Sepsis -Amyloidosis -Protein-Calorie Malnutrition -Hemorrhage -Dyspnea/hypoxemia -Leukopenia |
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What are Contraindications for Renal Transplant
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Active Glomerulonephritis
Active Infection Active or Very Recent Malignancy HIV Hep B Surface Antigenemia Severe Cormobities (vascular disease) just read em/consider them --kramers penis is smaller than mine |
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What are some RELATIVE contraindications for Renal Transplant?
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Age > 70 yrs
Severe Psychiatric Dz Moderately Severe Comorbs -Hep C with chronic Hepatitis or cirrhosis Noncompliance with dialysis or other Tx Immunosuppression/neoplasm Other Primary Renal Dzz |