CKD Flashcards
(42 cards)
3 Primary Kidney Functions
- Filtration of blood
- Regulation of fluid and electrolytes & acid base balance
- Excretion of metabolic waste products
3 Secondary Kidney Functions
To regulate:
1. BP (RAAS system)
2. Bone density
3. Erythropoiesis (RBC production)
What does the RAAS system stand for? What 3 factors regulate BP from the RAAS system?
Renin-angiotensin-aldosterone system
Regulates BP by increasing salt reabsorption, water reabsorption, and vascular tone
How does the RAAS system work?
Renin splits angiotensinogen into angiotensin I which is split by ACE (angiotensin-converting enzymes) in the lungs and kidney into angiotensin II which causes vasoconstriction and the release of aldosterone and ADH in the adrenal gland which causes salt retention (more water in body increases BV and BP) and K+ excretion in urine
CKD is defined by the presence of:
either kidney damage or GFR < 60 mL/min/1.73 m2 for 3 months or longer
Description of stage 5 CKD
End-stage Renal Disease (ESRD)
Kidney failure, GFR <15 (or dialysis), action is renal replacement therapy (if uremia present and Pt desires treatment)
Normal GFR
125 mL/min
Leading causes of ESRD
DM (38%), Renal vascular disease (50%)
2 ESRD tx options
Renal Replacement Therapy (either HD or PD)
Transplant
2 General Clinical manifestation of CKD
- Retained Urea, creatinine, phenols, hormones, electrolytes, and water
- Uremia (when GFR<10, syndrome that incorporates all S&S seen in various systems throughout body due to waste product retention and excess fluid)
Psychological S&S of CKD
anxiety, depression (changes in body image with devices)
CV S&S of CKD!!
HTN (fluid retention)
HF
L ventricular hypertrophy (has to work harder)
Peripheral edema
Dysrhythmias
Uremic pericarditis
CAD
Peripheral artery disease
GI S&S of CKD
Anorexia
NV (increased urea circulating)
GI bleeding
Gastritis
Inflammation of GI mucosa (increased urea circulating)
Uremic fetor (urine breath odor)
Constipation (limited fluid intake)
Endocrine/Reproductive S&S of CKD
Hyperparathyroidism
Thyroid abnormalities
Amenorrhea
Erectile dysfunction
Infertility
Decreased libido
Low sperm counts
Metabolic S&S of CKD
Carbohydrate intolerance: Insulin resistance d/t insulin antagonists (ex. urea, a waste product) circulating = hyperglycemia and a need for less insulin because it’s already circulating but the waste prevents it from acting. Insulin is dependent on kidneys for excretion.
Hyperlipidemia: hyperinsulinemia stimulates triglyceride production in liver
Waste product accumulation - Kidney can’t filter out wastes, GFR ↓ and BUN ↑ and serum creatinine levels ↑
Hematological S&S of CKD
Anemia: decreased erythropoietin production (what stimulates RBC production in bone marrow), causes fatigue and SOB (increased O2 demand). Angina is secondary to anemia in a predisposed Pt (like a smoker).
Bleeding: defect platelet function, usually corrected with PD or HD
Infection: changed leukocyte function, diminished inflammatory response
Neurological S&S of CKD
fatigue, headache, sleep disturbances, encephalopathy, restless legs syndrome, muscle twitching, apathy, decreased ability to concentrate, peripheral neuropathy
Because of increased nitrogenous waste, electrolyte imbalance, metabolic acidosis, axonal atrophy, and demyelination of nerve fibers. Most change once on dialysis
Ocular S&S of CKD
HTN retinopathy
Respiratory S&S of CKD
Kussmaul’s resps
Dyspnea
Pulmonary edema (fluid overload)
Uremic pleuritis
Uremic pneumonitis
Pleural effusion
Predisposition to respiratory infection
Integumentary S&S of CKD
Pruritus (most common - d/t increased serum urea)
Ecchymosis
Dry, scaly skin
Uremic frost
Musculo-skeletal S&S of CKD
Osteomalacia (bone demineralization)
Osteitis fibrosa (↑ PTH)
CKD-MBD (CKD mineral and bone disorder)
Vascular and soft tissue calcification (↑ serum Ca, ↑ serum phosphate)
Decreased kidney function → less conversion of activated Vit D which is essential for Ca absorption in GI → Hypocalcemia → causes PTH excretion → stimulates bone demineralization → releases phosphate → hyperphosphatemia decreases Ca serum → causes PTH excretion → parathyroid gland hypertrophy
Peripheral neuropathy S&S of CKD
paresthesia, restless legs syndrome
GU S&S of CKD
Polyuria - in early stages due to inability of kidneys to concentrate urine. Often nocturia. 1.010 specific gravity.
Oliguria - in worsening stages. < 400-500 mL/day
Anuria - urine output < 40mL/day
Electrolyte/Acid-Base imbalances
K: Hyperkalemia - most serious electrolyte disorder in kidney disease, can cause fatal dysrhythmias when K+ > 7-8 mmol/L in blood. Kidneys not able to excrete K+ into urine.
Na+ : Dilutional hyponatremia - retained longer with water causing edema, HTN, CHF
Ca and phosphate (PO₄³⁻) alterations
Mg alterations
Metabolic acidosis: HCO3 can’t be reabsorbed (plasma bicarb falls to 16-20 mmol/L), makes body less basic and more acidic, as well acidic ammonia can not be excreted
