ARF + CRF - final Flashcards
(20 cards)
ARF- Signs and symptoms
SYMPTOMS
- uremia: n/d, malaise, alt mental
- perfusion defects: edema (central or general), dizzy
- electrolyte abnorm: abd pain/ileus
SIGNS
- pericardial effusion (friction rub)
- electrolyte abnorm: arrythmias
- platelet dysfunc: bleeding
- neuro findings
ARF
- pre renal BUN:creatinine ratio
BUN:creatinine > 20:1
- due to inc urea reabsorp
ARF
- renal (intrinsic) causes
- refer when?
- admit to hospital?
- acute tubular necrosis
- interstitial nephritis
- glomerulonephritis
refer: nephro if signs present for 1-2 weeks no acute uremia, urologist if signs of urinary tract obstruction
admit to hospital: sudden loss of func + abnorm that cannot be safely managed outpt
ARF
- post renal findings
- anuria or freq but small volume voids
- suprapubic pain (distended bladder)
- palpable or percussed distended bladder or enlarged prostate
- high BUN:creatinine ratio
- US can find location of obstruction
ARF
- post renal tx
- bladder cath, allow release of urine
- correct underlying cause
- saliuresis and diuresis`
ARF immediate dx critical if you suspect
- dec renal perfusion (test volume status + urine output)
- glomerulonephritis (test for urine sediment, serologic tests)
- UTO (renal US dx)
ARF
- contrast induced injury RISK REDUCTION
- non pharm vs pharm
NON pharmacologic
- use lowest dose IV contrast, adequate hydration, dec exposure to nephrotoxic meds
PHARMACOLOGIC
- IV volume expansion w isotonic saline or soidum bicarb in high risk pts (renal protective)
- oral n-acetycysteine given prior (allergic rxn may occur)
- avoid diuretic use
ARF tx
- when to do renal replacement therapy v dialysis
- when to discont dialysis
- initiate renal replacement therapy if life threatening fluid, electrolyte, or acid-base abnorm
- dialysis to maintain homeostasis and prevent further injury/permit renal recovery, allow tx of underlying condition
DISCONT when patient able to maintain own ability (trials)
CKD
- pre renal causes
hypoperfusion
- renal artery stenosis (fibromuscular dysplasia)
- extrinsic compression
- dec renal perfusion pressure from CHF
- dec oncotic pressure (cirrhosis, nephrotic syndromes)
CKD
- intra renal causes
intrinsic renal vasc ds
- renal artery stenosis
- glomerulosclerosis
- recurrent thromboembolic ds
glomerular ds
- nephritis/nephrotic syndromes
tubular and interstitial ds
- nephrocalcinosis due to hypercalcemia
- systemic lupus erythematosus (SLE)
- polycystic kidneys ds (mc genetic cause)
- autoimmune
CKD
- post renal causes
chronc obstruction
- BPH, neoplasm, calculi/tumors/clots, hyperplasias, strictures, inflamm
pathophys of CKD mechanisms of damage
intiating phase- nephron mass loss(first insult to kidneys)
- immune complexes (deposit in kidneys and cause inflamm)
- HTN/DM
progressive- maladaptive compensatory changes
- RAAS activation
- hyperfiltration of remaining viable nephrons
- release vasoactive hormones, cytokines, growth factors
- hypertrophy and sclerosis
- reduce renal mass more
hematologic effects of CKD
anemia
- primary cause: EPO def
- other cause: iron def, anemia of chronic ds, BM fibrosis
tx: recombinant EPO
impaired platelet function
- primary cause: uremia (dec activity platelet factor 3, abnorm aggregation, prolonged bleeding time)
impaired immune function
- primary cause: uremia (WBC suppression)
- other factors: acidosis/malnutrition
CKD secondary prevention
- after RFs begin (DM/HTN)
- inititate aggressive tx
- targeted drug regiment (ACEi in DM)
- aggressive screening for renal involvement before progressing to renal ds
avoid these to stop progression of renal ds
- avoid med/tx that further damage kidney function–> IV contrast, NSAIDs, aminoglycosides (-mycin)
delaying progression of renal ds
- HTN
- dyslipidemia
- DM
- DM with proteinuria
aggressive tx underlying cause
HTN
- BP management with goals <120/80
dyslipidemia
- LDL goal of 100, TG tx
DM
- glycemic control, goal A1c <7%
- CAUTION oral hypoglycemics in advanced CKD
- METFORMIN can lead to lactic acidosis
- thiazolidinediones inc cardiac events
DM with proteinuria
- ACEi, monitor K+
CKD management
- renal replacement therapy
- dialysis
- renal transplantation
RENAL REPLACEMENT/TRANSPLANT
stage 4- prep for kidney replacement
- GFR 15-29
stage 5- kidney replacement tx
- GFR <15
dialysis
- hemodialysis
- peritoneal dialysis
- need before transplant typically
hemodialysis v. peritoneal dialysis
- access?
- complications
hemo
- mc form renal replacement
- vascular access, AV FISTULA, graft, or venous cath
- complication: hypotension, muscle cramp, anaphylatoid rxs
peritoneal
- infuse dextrose containing solution in peritoneal cavity, dwell for period of time
- access w peritoneal cath
- complications: peritonitis, metabolic complications
donor selection for renal transplant
- live v deceased
live
- fam relative match w HLA
deceased
- test HIV/hep neg serology
- malignancy/fail risk
post transplant complications
malignancy
- 5-6 % patient on immunosuppressive therapy will develop cancer
hypercalcemia
HTN
hepatitis
- immunosupp therapy dec immune control of hep B and C (test prior to transplant)
