chronic kidney disease and dialysis

Question 1

chronic kidney disease defined

Answer 1

abnormality of kidney structure of function that persists for > 3 months

Question 2

main CKD diagnostic criteria

Answer 2

GFR <60cc/min or structural and functional abnormalities with a preserved GFR (>90 cc/min)

Question 3

kidney failure/ESRD GFR

Answer 3

<15 ml/min/1.73m2 and on dialysis or some type of RRT

Question 4

there is a normal decline in GFR with ____ due to ____

Answer 4

age

scarring

Question 5

initial lab findings of CKD

Answer 5

decreased GFR

elevated Cr/BUN

Question 6

Cr and BUN are _____ in CKD because…..

Answer 6

elevated

renal function is impaired so it is not being cleared and excreted

Question 7

3 common causes of CKD

Answer 7

DM
HTN
GN

Question 8

how can diabetes lead to CKD?

Answer 8

hyperglycemia leads to kidney cell damage and sclerosis/thickening of nephrons

Question 9

how does HTN lead to CKD?

Answer 9

increased BP leads to sclerosis of afferent arterioles and decreases perfusion = ischemic damage

Question 10

CKD complications

Answer 10

(Kidney OUTAGES)
hyperKalemia
renal Osteodystrophy
Uremia
TGs
Acidosis (metabolic)
Growth delay
Erythropoietin deficiency
Sodium/water retention

Question 11

reduced GFR leads to decreased____

Answer 11

excretion

Question 12

clinical presentation of CKD

Answer 12

asymptomatic until later stages
presents as uremia (N/V, altered mentation, cramps, fluid overload)
fatigue, weakness, headaches

Question 13

derm manifestations of CKD

Answer 13

pruritus due to uremia

pallor due to anemia

Question 14

GI manifestations of CKD

Answer 14

N/V
anorexia
ammonia breath

Question 15

neuro manifestations of CKD

Answer 15

asterixis
encephalopathy
peripheral neuropathy

Question 16

why does CKD cause anemia

Answer 16

Erythropoietin deficiency (made by kidney) leads to decreased RBC production

it is worsened by uremia which causes RBC lysis

Question 17

treatment of anemia due to CKD

Answer 17

replete iron and B12

exogenous EPO

Question 18

why does CKD cause metabolic acidosis?

Answer 18

decreased GFR means that kidney cannot excrete all the acid so it accumulates in the blood

Question 19

why does CKD cause renal osteodystrophy

Answer 19

failing kidneys cannot eliminate phosphate properly = hyperphosphatemia and they cannot convert vitamin D to its active form = decreased calcium absorption and PTH activation

Question 20

osteitis fibrosa cystica is due to ____ which causes____

Answer 20

overproduction of PTH in secondary hyperparathyroidism which causes bone breakdown by osteoclasts

Question 21

osteomalacia

Answer 21

aluminum in bone causes defective mineralization and increased matrix synthesis

complication of CKD

Question 22

CKD causes bone disorders due to two electrolyte imbalances (describe them) that both lead to increased ____

Answer 22

hyperphosphatemia
kidneys unable to make active vitamin D= low Ca

increased PTH

Question 23

adynamic bone disease

Answer 23

low bone turnover related to over suppressed PTH (no osteomalacia)

Question 24

renal osteodystrophy treatment

Answer 24

active vitamin D or calcium

Question 25

hyperphosphatemia in CKD pts can lead to

Answer 25

deposition of calcium phosphate in blood vessels = calcific arteries

Question 26

Hyperphosphatemia treatment

Answer 26

low phosphorus diet | phosphate binders to increase excretion

Question 27

why does hyperkalemia occur in CKD and why is it dangerous

Answer 27

kidneys excrete K potassium can cause arrhythmias

Question 28

indications for dialysis

Answer 28

``` Acidosis Electrolyte abnormalities Ingestion of toxins Overload Uremic symptoms ```

Question 29

goal of dialysis

Answer 29

to remove nitrogenous waste and replenish bicarbonate

Question 30

broad waxy casts are seen in

Answer 30

ESRD

Question 31

hemodialysis average time and frequency

Answer 31

4 hours 3x a week

Question 32

dialysis with lower risk of infection and enhanced quality of life

Answer 32

peritoneal dialysis

Question 33

peritoneal dialysis

Answer 33

solutes are exchanged between peritoneal blood supply and dialysis solution

Question 34

osmotic agent in dialysis

Answer 34

dextrose

Question 35

peritonitis organisms are most likely gram ____

Answer 35

positive (staph)

Question 36

indication for transplant

Answer 36

when GFR is <15

Question 37

chest pain with inhalation, friction rub on auscultation, CKD complication

Answer 37

uremic pericarditis

Question 38

_____ is the leading cause of death in patients undergoing dialysis

Answer 38

CVD

Question 39

best predictive test for CKD progression

Answer 39

urinary albumin/Cr to measure proteinuria

Question 40

what would a CKD pts PT/PTT and platelet count look like?

Answer 40

TRICK question they would all be normal because the increased risk of bleeding because of uremia is due to platelet aggregation dysfunction (bruises