Kidney diseases

Question 1

Is kidney injury a slow process?

Answer 1

NO - rapid progression

Question 2

Fxn of kidneys

Answer 2

F&E homeostasis, rid body of water-soluble waste (many drugs) via urine, endocrine functions like making erythropoietin, activating vit D, making renin (regulate BP)

Question 3

Is kidney injury reversible?

Answer 3

It can be

Question 4

What is GFR a measure of?

Answer 4

how well the kidneys are working; insufficiency is 25% of normal GFR

Question 5

Are kidneys greedy?

Answer 5

Yes - require 1L/minute of blood (20% CO)

Question 6

AKI

Answer 6

body causes inflammation when it sense injury causing inc kidney cell death

Question 7

Causes of AKI

Answer 7

ischemic injury r/t loss of blood volume and dec perfusion from toxins (OD) or sepsis (3rd space), acute blood loss

Question 8

Pre-renal AKI

Answer 8

volume loss (surgery) or dehydration
- most common

Question 9

intrarenal AKI

Answer 9

acute tubular necrosis (drug OD, kidney cell death), vascular disease, glomerulonephritis

Question 10

post-renal AKI

Answer 10

not as common, obs causes cell death, tumor; in ureter or bladder

Question 11

CM of AKI

Answer 11

1st day after hypotensive event and lasts 1-3 weeks; oliguria, FVE (edema), metabolic acidosis, hyponatremia, hyperkalemia, waste product accumulation, neuro dx

Question 12

Oliguria of AKI

Answer 12

under 400 mL/24h or under 30 mL/1h

Question 13

Tx for AKI

Answer 13

address cause, fluids, drug antidote, electrolytes, address fluid shift

Question 14

What determines the stage of injury with CKD?

Answer 14

GFR

Question 15

Stage 5 CKD

Answer 15

urinemic - urea in blood; excess AA in metabolic end products
- urine in blood bc body can’t excrete

Question 16

Best tx for CKD

Answer 16

Prevent by controlling causes (often chronic conditions like DM - 1, HTN - 2, glom or AKI, other probs)

Question 17

Risks for CKD

Answer 17

family history, CAD, HLD, atherosclerosis, older than 60Y, men, Black, HTN, DM, SMOKING, overwt and obese

Question 18

Patho of CKD

Answer 18

lack BF to kidney cells and proteinuria from leaky GBM accumulates in the interstitial space in nephrons, causing injury; inflammatory system activated and angiotensin 2 activates, causing arterial vasoconstriction which normally would inc glom HTN but due to the leaks it causes more proteinuria

Question 19

CM of CKD

Answer 19

Most body sys are affected by waste products from the kidneys are everywhere
- inc systemic inflammation

Question 20

Integumentary sx of CKD

Answer 20

itchy, red, dry, scaly

Question 21

Psych sx of CKD

Answer 21

anx and dep

Question 22

Neuro sx of CKD

Answer 22

fatigue, HA, sleep prob, encephalopathy

Question 23

CV sx of CKD

Answer 23

heart failure, HTN, CAD, pericarditis, PAD

Question 24

GI sx of CVD

Answer 24

anorexia, N/V, gastritis, bleeding

Question 25

What sign of CVD indicates dialysis is needed?

Answer 25

Pulmonary edema - biggest concern

Question 26

CKD fx of poor F&E homeostasis

Answer 26

edema, INC K, inc P, and inc Mag, metabolic acidosis

Question 27

CKD CM of no waste ridding

Answer 27

anorexia, malnutrition, itching, CNS change from things crossing BBB (AMS), uremic frost

Question 28

CKD fx of dec erythropoitein

Answer 28

anemia; gradual adjustment to hgb of 5 or 6

Question 29

CKD fx of dec activation of vit D

Answer 29

renal osteodystrophy, weak bones

Question 30

Drugs used to slow progression of CKD

Answer 30

ACE inhibitors OR ARBs - keep BP under 140/90 Tx HLD (under 200) with statins, diet

Question 31

How to tx CKD

Answer 31

Tx the symptoms and complications with usual tx - overload (diuretics and low salt), inc K (hemodialysis, Kayexalate), acidosis (NaHCO3), hyperphos (phosphate binder like Calcium carbonate) anemia (erythropoitein), renal osteodystrophy (calcitriol--activated vit D)

Question 32

Drug monitoring with CKS

Answer 32

- dec drug elimination with CKD - monitor levels closely - may need to adjust to kidney fxn - RENALLY DOSED

Question 33

Which drugs do you need to watch closely with CKD?

Answer 33

Digoxin, diabetic agents like glyburide, Metformin, abx like VANC, opioids (can cause severe resp dep bc kidneys won't clear it)

Question 34

Normal GFR

Answer 34

Over 90

Question 35

Stage 1 and 2 CKD CM

Answer 35

Often asymptomatic

Question 36

Stage 3 CM

Answer 36

HTN - tx it

Question 37

Why don't we want to lower BP too much?

Answer 37

Kidneys won't get perfused at the rate that they are used to - slow titration - goal is SBP 110-130