19 - Care of the Renal Patient Flashcards Preview

GI and Renal Exam 2 > 19 - Care of the Renal Patient > Flashcards

Flashcards in 19 - Care of the Renal Patient Deck (45)
Loading flashcards...
1

What are the three types of renal failure?

Pre renal – (volume, renal artery stenosis)

Intrinsic – (toxins, infection, genetic)

Post renal – (stone)

2

What can cause acute renal failure?

- Toxins (nsaids, etoh, anti-freeze)
- Dehydration/fluid (shock)
- Rhabdo
- Infection
- Trauma
- CHF
- Stones

3

What can cause chronic renal failure?

***

- DM***
- HTN***
- CHF
- Autoimmune
- Infection (HIV)
- Inflammation (post-strep)***
- Polycystic kidney (#1 genetic; 6-8% dialysis)
- Drugs/toxins

4

Describe the incidence of chronic renal failure

- Number of people with CRF has more than doubled since 1990
- 54% of that increase not due to DM or HTN

5

What are the risks to getting renal disease?

**** TEST QUESTION ****

- DM
- Smoking
- HTN
- Obesity
- Cholesterol
- African/Eastern
- FMHx
- >65 y/o

6

Describe the increase in hospitalizations due to kidney disease

CDC – hospitalizations from kidney disease 4X 2005 compared to 1980

7

Why is hospitalization a big risk for new renal failure?

- 1% admitted to hospital dx RF
- 2 - 5% get ARF, double mortality
- Use of contrast
- Drugs (NSAIDS and ABX)
- Sepsis
- Surgery
- Hypo perfusion

8

Describe diabetes and renal failure

- 25-40% of type 1 (longer disease)
- 5-15% of type 2

9

Describe the renal disease implications for the lower extremities

**** TEST QUESTION ****

- Muscle infarct
- Osteoporosis/osteopenia
- Poor microcirculation
- Increased fx risk
- Tendon rupture
- ESRD – amputation 10X risk (2/3 of these amputations die within 1st year)

10

What type of history is suspicions for RF

- DM
- HTN
- Autoimmune DZ
- Age
- Family history
- Meds

11

Describe the ROS that hints toward renal disease

- Change in urination
- Neuropathy
- Unexplained FX
- LE edema
- SOB
- Fatigue
- N/V
- Itching

12

What does renal disease do to the bone?

*** TEST QUESTION ***

- Phosphorus and calcium inversely related
- RF leads to high phosphate
- Pulls calcium out of the bone

13

What in the physical exam could make you suspicious of renal disease?

- HTN
- Ascites
- LE edema
- Pulmonary crackles
- Rashes

14

What in the lab results could make you suspicious of renal disease?

- BUN/Cr.
- Increased K (some rare types low K)
- Increased Phos
- Decreased Ca
- Anemic

15

What can you do as a doctor to protect the patient's kidneys?

**** TEST QUESTION ****

- Prevent hypotension during surgery (limit time of surgery when possible)
- Prevent hypovolemia
- Avoid nephrotoxic medicines
- Encourage hypertension and diabetic treatment compliance
- Encourage to quit smoking

16

What meds are hard on the kidneys?

- NSAIDS
- Contrast (CT) - don't mix contrast and metformin
- Certain antibiotics
- Diuretics
- Certain diabetic meds

17

Describe the NSAID evils

- Can lead to resistant HTN
- Decreases prostaglandins (vasodilating)
- Increases systemic resistance
- Decreases Na excretion
- In RA, 8-27% increase in Cr. Over NML
- CHF

Need to do Cr checks if long term use

18

Describe NSAIDs and hypertension

- Can block some of the effects of diuretics, Beta Blockers and others
- Normal healthy people adjust

NSAIDs are vasoconstrictors

19

What meds clear slowly with renal failure?

*** TEST QUESTION ***

- Insulin
- Narcotics
- Benzos
- Some ABX

**********

20

Describe aminoglycosides and kidney failure

- Build up in proximal tubules 10 x serum level
- Can cause renal problems in 20% after 5-7 days
- Monitor levels
- Good news is these ABX are now used less

21

Describe the use of other antibiotics in kidney failure

- Cr clearance decides freq/dose
- Hard on kidneys – FQ, Bactrim
- Easy – PCN based, cephalosporins

22

Describe kidney damage due to contrast

*** TEST QUESTION***

- Cause unclear – hypo-perfusion or direct toxicity
- Higher risk in renal compromised, nephrotoxic drugs, dry
- 48 hours after contrast (recent change)
- Hydrate
- Pre-medicate Mucomyst
- Stop metformin 2 days past contrast (can stop prior if know before-hand)

23

Describe ACE inhibitors and renal protection

- Very renal protective, but we stop them during times of decreased renal function
- If someone put on ACE and Cr increases >30% look for pre-renal issue

24

Describe acute tubular necrosis

- Tubes connect the glomeruli
- Very metabolically active; sensitive to low fluid/O2
- Ischemic – hypotension, sepsis, prerenal, hypovolemia
- Nephrotoxic – aminoglycosides (gent), NSAIDS, cancer TX, contrast, rhabdo

25

What do we see in acute tubular necrosis?

- Increase in BUN, Cr
- Brown, granular casts
- Take off nephrotoxic meds
- Usually resolves 1-3 weeks

26

What is acute interstitial nephritis?

- Tissue around glomeruli and tubules get inflamed
- Usually allergic rxn to meds or infection
- PCN, NSAIDS, post strep, sarcoid

27

Describe the diagnosis and treatment of acute interstitial nephritis

- Dx – biopsy; sometimes eosinophils in urine
- TX – actually responds to steroids

28

How do you monitor renal function?

- UA
- Urine microalbumin (in diabetics, nephrotic)
- Creatinine, BUN
- Creatinine clearange (age, muscle mass)

29

Describe the use of dialysis

- 3-4 hours 3x/week
- Fatigue before and after; feel good day after
- Low NA, low protein, low fluid diet
- Cost - $90,000/year

30

What meds are dialysis patients on?

- Lasix
- BP meds
- Multivitamins, Ca supplements
- Epogen (RBC production)
- Phosphate binders
- Fe supplements