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Flashcards in 3: Chronic Renal Failure Deck (14):
0

Chronic Renal Failure- definition

Progressive and Irreversible
Chronic reduction in GFR
Accumulation of Nitrogenous waste that affect multiple organs

1

Chronic Kidney Disease (CKD)- 6 phases

0: Normal kidney GFR: 120-90
1: Diseased kidney GFR: 120-90
2: Kidney disease with mild reduction in GFR GFR: 90-60
3: ""with Moderate "" GFR: 60-30
4: ""GFR: 30-15
5: ESRD GFR: <15
CRF: GFR is less than 60mm/min/1.73m2BSA (body surface area)

2

CRF Ddx Acute

Small shrunk kidney
Anemia
Osteodystrophy (bone deformity)
Proteinuria

*Bid kidney with CRF: Polycystic kidney disease, Diabetic nephrosis

3

MCC of CRF

1: Diabetes
2: HTN
3: Polycystic kidney disease

4

Electrolytes- CFR

Hypothermia (Na/K pump is dysfunctional, thus cannot use the pump to increase the body temp)
Metabolic acidosis
Hyperkalemia
Hyperphosphatemia
Hypocalcimia (causes increase in PTH and bone deformation)

5

Hormones-CRF

Increase:
PTH
LH/Prolactin (reduced level of testosterone and estrogen)
Insulin (kidney cannot break it down)
Decrease:
Estrogen/ Testosterone (toxin build up)
EPO
1,25-(OH)2-D3

6

Protein/Fat/Carbs- CRF

Protein- Depleted
1: renal loss
2: reduced intake
3: acidosis/ Toxin (ubiquitin, proteasome) depletes protein
Fat- Atherogenic Fat is higher (high LDL, triglycerides)
Carbs- Hypoglycemia (high insulin)
*if it is non-diabetic cause of CRF, increased peripheral insulin resistance: pseudo-diabetes**

7

General appearance-CRF

Skin- pale, bruising, achemosis, Uremic frost (deposition of toxin on skin), Uremic breath (ammonia in mouth), Urochroms (dark pigmentation)

8

Neurological sx-CRF

Central-
Early- confusion, sleep disturbance
Late- cramps, hiccups* (neuromuscular)
Severe- encephalopathy
Peripheral- restless leg syndrome (tx: clonazepam)
Distal > proximal
Lower limb>Upper limb
Sensory>motor
ANS-

9

Musculoskeletal sx- CRF

Muscle-
Wasting
Weakness
Bone- renal osteodystrophy
Osteopenia-> Osteoporosis (low estrogen)
Osteomalacia: defective mineralization (vitD deficiency)
Osteitis fibrosa cystica: High turnover-> empty space-> brown cyst

10

GI sx-CRF

Gastritis, Pancreatitis, Hepatitis, etc
Bleeding
Nausea
Vomiting

11

Cardio sx-CRF

CHF
Calcification of vessels
Cardiac effusion
etc

12

Imaging

U/S- size of kidney
Dextrose scan: bone density
Bx: amyloidosis
PT, PTT

13

Management

Stop the insult
Electrolyte tx
symptomatic tx
Renal replacement tx
-Dialysis (Hemo or Peritoneal)
-Transplantation