Acute Uremic Crises

Question 1

Pair the following patient descriptors with acute versus chronic azotemia:

• Feeling sick with mild to moderate azotemia
• Anemic
• Good MCS
• Small, irregular kidneys
• Not anemic
• Stable with moderate to severe azotemia
• Painful and/or enlarged kidneys
• Poor MCS

Answer 1

• Feeling sick with mild to moderate azotemia (Acute)
• Anemic (Chronic)
• Good MCS (Acute)
• Small, irregular kidneys (Chronic)
• Not anemic (Acute)
• Stable with moderate to severe azotemia (Chronic)
• Painful and/or enlarged kidneys (Acute)
• Poor MCS (Chronic)

Question 2

What are common presenting complaints with CKD patients that are now newly/suddenly sick?

Answer 2

(Dehydration, anorexia, vomiting, weakness, lethargy)

Question 3

(T/F) Prerenal azotemia is the only kind of azotemia that resolves with fluid therapy.

Answer 3

(T)

Question 4

Why should maintenance fluids in a CKD patient be discontinued gradually, often over 2-3 days when possible?

Answer 4

(Avoids dehydration or hypovolemia and recurrence of prerenal azotemia)

Question 5

Why is LRS better for the kidneys when rehydrating?

Answer 5

(It is balanced which means lower in chloride which can be not optimal for injured kidneys; make sure to stop LRS as soon as the CKD patient is no longer dehydrated)

Question 6

What are the two administration options for supplemental at home fluids in CKD patients?

Answer 6

(Subq fluids or esophagostomy tube)

Question 7

What are the pros and cons of at home subq fluids for tx of dehydration in CKD patients?

Answer 7

(Pros → easy, inexpensive initially; cons → excess salt (have to use an isotonic fluids for subq fluids), patient tolerance, and client abilities)

Question 8

What are the pros and cons of at home fluids given via an esophagostomy tube?

Answer 8

(Pros → more physiologic (no extra salt, can literally use tap water), can adm meds easier, improved patient tolerance, and ease of administration; cons → requires general anesthesia, increased up-front cost, potential complications (stoma infection, dislodgement of tube, esophageal stricture))

Question 9

Why are phosphorus binders included in treatment of CKD patients?

Answer 9

(Phosphorus clearing is dependent on GFR which is decreased with CKD, CKD patients will have high phosphorus and that contributes to nausea/discomfort and can worsen kidney function, phosphorus binders ameliorate that)

Question 10

(T/F) Dietary changes to a prescription renal diet should be recommended to every CKD patient and that change may slow progression of CKD and extend life-expectancy.

Answer 10

(T)