11: Endocrine Case Study- Mahoney

Question 1

primary v. secondary chronic renal failure

Answer 1

1- chronic glomerulonephritis, interstitial nephritis

2- diabetes, hypertension

Question 2

clinical definition of chronic renal failure

Answer 2

GFR less than 60 ml/min for > or = to 3 month plus kidney damage

Question 3

pathology of chronic renal failure

Answer 3

• kidneys reduced in size due to interstitial fibrosis and tubular loss
• glomeruli solidified
• intimal thickenin in large and small renal a
• acquired cystic disease
• defect in glomerular filtration —> elevation of serum BUM amd creatinine
• defect in tubular handling

Question 4

blood changes with chronic renal disease

Answer 4

anemia and impaired platelet aggregation

Question 5

why would triglyceride levels be bad in chronic renal disease?

Answer 5

reduced lipoprtn lipase and increase in poratherogenic LDL and VLDL

Question 6

why hypocalcemia with chronic renal disease? how does this affect bone?

Answer 6

renal retention of phosphate and decreased intestinal absorption of calcium due to impaired conversion of vit D to active form in the kidney

Question 7

what type of hyperparathyroidism do you see?

Answer 7

seconday – causes subperiosteal bone reabsorption “brown cysts”

Question 8

“brown cysts”

Answer 8

osteitis fibrosa cystica

Question 9

elevation of alkaline phosphatase?

Answer 9

incrased osteoblastic activity

proliferation of osteoclast and blast in renal ostoeodystrophy

Question 10

renal osteodystrophy aka

Answer 10

uremic bone disease

Question 11

*** bone changes brought about by (2)

Answer 11

1) abnormal metabolism of vit D
2) overproduction of PTH
3) chronic metabolic acidosis

Question 12

renal retention of phosphate causes …

Answer 12

hyperphosphatemia and further hypcalcemia –> increased synthesis and secretion of PTH

Question 13

when do phosphate levels begin to rise with renal failure?

Answer 13

when GFR around 60 ml/min which is regarded as only a moderate decline

Question 14

*** renal osteodystrophy lab findings

Answer 14

• hyperphosphatemia
• hypocalcemia
• elevated alk phos
• increased PTH levels

Question 15

changes that worsen as GFR decreases

Answer 15

• Hgb decreases and erythropoietin production is faulty
• calcium decreases
• Vitamin D decreases
• Albumin decreases
• PTH increases
• Phosphate increases
• Homocysteine increases
• Inflammatory cytokines increase

Question 16

treatment?

Answer 16

reduction of dietary intake of phosphate (aluminum hydroxide)
dietary supplementation with vit D

Question 17

four core principles of motivational interviewing

Answer 17

• express empathy
• develop a discrepancy
• roll with resistance
• support self-efficacy