End-Stage Renal Disease

Question 1

What is End-stage renal disease (Chronic Renal Failure)?

Answer 1

kidney failure so severe it requires dialysis or renal transplant. Massive loss of renal function leading to characteristic symptoms and labs (uremia)

Question 2

What are the most common causes of End-stage Renal Disease?

Answer 2

Diabetes and Hypertension

Question 3

What is Uremia defined as?

Answer 3

Metabolic Acidosis
Fluid Overload
Encephalopathy
Hyperkalemia
Pericarditis

Conditions for which dialysis is the treatment

Question 4

What are common clinical manifestations of Renal Failure?

Answer 4

Anemia
Hypocalcemia
Osteodystrophy
Bleeding
Infection
Pruritus
Hyperphosphatemia
Hypermagnesemia
Accelerated atherosclerosis and hypertension
Endocrinopathies

Question 5

How does renal failure lead to Anemia?

Answer 5

Loss of EPO leads to normochromic, normocytic anemia

Question 6

How does renal failure lead to Hypocalcemia?

Answer 6

The kidney normally activates 25-hydroxy-vit-D to 1,25-Dihydroxy-vitamin-D: without the activation the body will not absorb enough Ca from the gut

Question 7

How does renal failure lead to osteodystrophy?

Answer 7

Low Ca leads to secondary hyperparathyroidism which removes Ca from the bones making them soft and weak

Question 8

How does renal failure lead to bleeding?

Answer 8

PLTs will not work normally in a uremic environment: they will not degranulate and will not work

Question 9

How does renal failure lead to infection?

Answer 9

Neutrophils will not be able to degranulate and combat infection

Question 10

How does renal failure lead to Pruritus?

Answer 10

Urea accumulates in skin

Question 11

How does Renal failure lead to Hyperphosphatemia?

Answer 11

High Parathyroid levels release Phosphate from bones but the body is unable to excrete it

Question 12

How does Renal failure lead to Hypermagnesemia?

Answer 12

Loss of Excretory ability

Question 13

How does renal failure lead to accelerated atherosclerosis and Hypertension?

Answer 13

1 Cause of death in patients on dialysis

lymphocytes help to keep the arteries clear of lipid accumulation: uremia causes WBC to not function normally

Question 14

How does renal failure lead to Endicrionpathy?

Answer 14

F: anovulatory
M: low Testosterone, Erectile Dysfunction
Insulin increases but so does insulin resistance

Question 15

How is Anemia treated?

Answer 15

EPO replacement and Fe supplements

Question 16

How is Hypocalcemia and Osteomalacia Treated?

Answer 16

Replacement of Vit D and Ca

Question 17

How is Bleeding treated?

Answer 17

DDAVP: increase PLT function: only given if bleeding

Question 18

How is Pruritus treated?

Answer 18

Dialysis and UV light

Question 19

How is Hyperphosphatemia treated?

Answer 19

Oral binders

Question 20

How is Hypermagnesemia treated?

Answer 20

Restriction of High-Mg foods, laxatives and antacids

Question 21

How is Atherosclerosis treated?

Answer 21

Dialysis

Question 22

How is Endocrinopathy treated?

Answer 22

Dialysis, Estrogen and Testosterone replacment

Question 23

What are common drugs used to treat Hyperphosphatemia?

Answer 23

Sevelamer
Lanthanum
Calcium Acetate
Calcium carbonate
Cinacalcet and Etelcalcetide: inhibit PTH and mimic Ca on Parathyroid gland

Question 24

What are common complications of ESRD?

Answer 24

calciphylaxis and Nephrogenic Systemic fibrosis

Question 25

What is Calciphylaxis?

Answer 25

Calcification of blood vessels and skin vessel clotting and necrosis

Question 26

How do manage Calciphylaxis?

Answer 26

Normalize Ca and PO4 levels and increase dialysis Thiosulfate and Cinacalcet

Question 27

What is Nephrogenic Systemic Fibrosis?

Answer 27

Proliferation of dermal fibrocytes leading to hardened areas of fibrotic nodules in skin

Question 28

What is Nephrogenic Systemic fibrosis associated with?

Answer 28

Occurrence following MRI contrast agent Gadolinium in a patient with GFR<30

Question 29

What drugs are used to prevent rejection of Kidney Transplantation?

Answer 29

Calcineurin Inhibitors: Cyclosporine and Tacrolimus

Question 30

What are common adverse effects of Calcineurin Inhibitors?

Answer 30

Glucose Intolerance Tremors Kidney Injury