Chronic Renal Disease

Question 1

What is uremia?

Answer 1

toxicity due to waste product accumulation in the blood

Question 2

Why does HTN occur in CKD?

Answer 2

• increased ECF volume
• increased RAAS
• ANS dysfunction–> insensitive baroreceptors
• diminished vasodilators

Question 3

How does the kidney compensate for decreased nephrons and H+ balance?

Answer 3

NH4+ production is increased to keep acid balance normal until GFR falls below 20 –> then a non-anion gap metabolic acidosis can occur

Question 4

Chronic kidney disease (CKD) is defined as _______.

Answer 4

a permanent reduction in glomerular filtration rate (GFR)

Question 5

Name the 6 most common causes of CKD.

Answer 5

1. Diabetic nephropathy- most common
2. Hypertensive nephrosclerosis and Renal vascular disease
3. Glomerulonephritis
4. Polycystic kidney disease
5. Interstitial nephritis
6. Obstruction

Question 6

What are the skin disorders associated with uremia?

Answer 6

• pruritus
• hyperpigmentation
• easy bruising

Question 7

Overproduction of _____ hormone in response to hypocalcemia and _____ hormone in response to volume overload could contribute to many aspects of the uremic state.

Answer 7

parathyroid…..natriuretic

Question 8

What are the pulmonary disorders associated with uremia?

Answer 8

• pleuritis
• pulmonary edema

Question 9

What are the hemotologic disorders associated with uremia?

Answer 9

• anemia
• bleeding tendency

Question 10

What happens to sodium balance in CKD?

Answer 10

flexibility is lost- kidneys can’t appropriately adjust to changes in solutes and water

Question 11

How are creatinine and urea balanced in CKD?

Answer 11

they are kept proportional but in elevated amounts

Question 13

Decreased ______ of vitamin D contributes to bone disease and secondary hyperparathyroidism.

Answer 13

1-hydroxylation

Question 14

What are the cardiovascular disorders associated with uremia?

Answer 14

• pericarditis
• hypertension
• congestive heart failure
• coronary artery disease
• vascular calcification

Question 15

What are the Fluid and Electrolyte disorders associated with uremia?

Answer 15

• edema
• hyponatremia
• hyperkalemia
• hypermagnesemia
• metabolic acidosis
• volume expansion or depletion

Question 16

Decreased 1-hydroxylation of ______ contributes to bone disease and secondary hyperparathyroidism.

Answer 16

vitamin D

Question 17

What are the metabolic-endocrine disorders associated with uremia?

Answer 17

• glucose intolerance
• hyperlipidemia
• hyperuricemia
• malnutrition
• sexual dysfunction
• infertility

Question 18

Progression of chronic kidney disease is prevented by the administration of ______ or _____.

Answer 18

converting enzyme inhibitors…. angiotensin receptor blockers

Question 19

What are the GI disorders associated with uremia?

Answer 19

• anorexia
• nausea
• vomiting
• gastroenteritis
• gastrointestinal bleeding

Question 20

Decreased 1-hydroxylation of vitamin D contributes to _____ and _______.

Answer 20

bone disease; secondary hyperparathyroidism

Question 21

Why does anemia occur in CKD?

Answer 21

• decreased EPO
• shortened RBC lifetime
• decreased platelet function and blood loss
• marrow space fibrosis

Question 22

What are the neurological disorders associated with uremia?

Answer 22

• encephalopathy
• peripheral neuropathy

Question 23

How does potassium balance change in CKD?

Answer 23

plasma and total body K are maintained, but hyperkalemia can occur with sudden dietary K loads

Question 24

What are the psych disorders associated with uremia?

Answer 24

• depression
• anxiety

Question 25

What is the primary regulator of PTH?

Answer 25

calcium

Question 26

What are the bone/Ca++/PO4- disorders associated with uremia?

Answer 26

• hyperphosphatemia
• hypocalcemia
• dystrophic calcification
• secondary hyperparathyroidism
• 1,25-dihydroxy vitamin D3 deficiency
• osteomalacia
• osteitis fibrosa

Question 27

Do CKD pts have excess water or decreased water in the plasma?

Answer 27

they’r susceptible to both