Kidney Diseases Key Concepts (Midterm Review) Flashcards
1
Q
Give 5 signs of early CKD
A
- Weight loss
- Itching
- Swelling in ankles
- Loss of appetite
- Vomiting
- -> Mostly due to their uremic level state which is increasing
2
Q
Uremic state symptoms?
A
- Anorexia
- N/V
- CNS abnormalities
- Loss of concentration
3
Q
There is no _____ between the absolute serum levels of BUN and Cr in the development of Uremic symptoms
A
No
4
Q
Glucose normal vs dialysis?
A
Normal = 4.0-6.6 Dialysis = 18-35
5
Q
UN normal vs dialysis?
A
Normal = 2.0-9.3 Dialysis = 18-35
6
Q
CR normal vs dialysis?
A
Normal = 52-115 Dialysis = 600-1800
7
Q
Ca normal vs dialysis
A
Both = 2.15-6.65
8
Q
Pi normal vs dialysis?
A
Normal = 0.58-1.32 Dialysis = 0.58-1.7
9
Q
Normal K vs Dialysis?
A
Normal = 3.5-5.1 Dialysis = 3.5-5.5
10
Q
Albumin normal vs dialysis?
A
Normal = 32-50 Dialysis = 32-50 with goal of 40
11
Q
High glucose?
A
- Diabetes
- Long-standing urea
- 1-3 hrs post p.o
12
Q
Side effects of high glucose?
A
Thirst
13
Q
High urea?
A
-Too much protein
14
Q
Low urea?
A
-Inadequate protein and /or energy
15
Q
Side effects of high urea?
A
-Anorexia, N/V, fatigue, bad taste in mouth, hyperkalemia
16
Q
Side effects of low urea?
A
LBM breakdown
17
Q
High creatinine?
A
- Not enough dialysis
- LBM loss
18
Q
Side effects of high creatinine?
A
- Anorexia
- Nausea
- fatigue
- Weight loss
19
Q
High calcium?
A
- Supplements
- Vit D
- High CaIntake
- HyperPT
20
Q
Low calcium
A
- High PO4 intake
- Not taking PO4 binder with meals
21
Q
Side effects of high calcium?
A
-Muscle weakness, consitipation, fatigue, N/V, anorexia
22
Q
Side effects of low calcium?
A
-Twitching, cramping, tingling fingers, hair loss, depression
23
Q
Low albumin?
A
- Inadequate protein and/or energy
- Recent infection
24
Q
Side effects of low albumin?
A
-Increased chance of infection, edema, weakness.
25
High Phos?
-Not taking binder w/ meals, too much protein
26
Low phos?
Too much PO4 binder, poor intake
27
Side effects of high phos?
-Itching, joint pain, easily broken bones, increased PYH
28
Side effects of low phos?
-Muscle weakness
29
High K+
-Too much f/v, additives, protein
30
Low K+
-Too little f/v, eating poorly
31
Side effects of high K+
-MI, arrhythmias, numbness/tingling in hands, death
32
Side effects of low K+
weakness
33
Tx if TGs are elevated?
- Reduce refined CHOs, alcohol
- Add omega-3
- Reduce BW, exercise
34
Typical lipid patterns in PD?
- Normal Chol
- High TG
- Low HDL
35
Why does the creatinine level increase in proportion of LBM breakdown? Why does this change with ethnicity?
As it is a product of LBM breakdown
| -In African Americans, they have more LBM and therefore are expected to have higher creatinine levels
36
Why abnormal lipid values in dialysis?
-Dextrose absorption from dialysate and protein losses into the PD contribute to impaired TG clearance
37
How can a patient compensate for a "salt outing"?
By reducing fluid until next dialysis (less hypovolemia)
38
Why may the nutritional diagnosis be due to inadequate food intake?
- Physiological factors (N/V, dysgeusia)
- Psychological factors (Emotional distress, anxiety)
- Social barriers (limited income, inability to prepare foods at home)
39
Why may the aetiology of systemic inflammation be related to?
- Dialysis
- Fluid status/volume overload
- GI bacterial overgrowth
- Failed kidney transplant
40
Endocrine disorders associated with uremia?
- Hyperparathyroidism
- Hyperglucagonemia (Increase glucagon, more gluconeogenesis and glycogenolysis leading to increased BG and insulin resistance)
- Resistance to the actions of insulin and IGF-1
41
What does metabolic acidosis result in?
Increased protein catabolism
42
When does renal bone disease develop?
In the early stages of CKD
43
Why do patients with CKD have decreased Ca absorption (2)?
- Altered metabolism of vitamin D
| - Inability to excrete phosphate or hyperphosphatemia
44
What does suboptimal calcium and phosphate regulation result in?
- Decreased calcium, or hypocalcemia
| - Hyperparathyroidism and renal osteodystrophy
45
What results in secondary hyperparathyroidism?
```
Failure of the endocrine function of the kidneys to
produce calcitriol (1,25 - dihydroxy cholecalciferol)
```
46
How should secondary hyperparathyroidism be treated?
Supplement with active form of Vit D: to increase
calcium absorption and raise serum calcium level and
suppress PTH secretion
47
How should hyperphosphatemia be controlled through diet? What are key offending items?
- Restrict to Phos of 12 mg/kg/day ORR 15 mg/gPro/day
| - Dairy, meat, fish, poultry, legumes, bits, bran, cola, chocolate, beer**
48
Other ways to control hyperphosphatemia?
- Use phosphate binders (Sevelamer --> Renagel --> Calcium free)
- Avoid aluminum containing binders
- Take binders with food
49
High calcium and phosphate solutes result in what?
-Metastic calcification in soft tissue areas, and can lead to renal osteodystrophy
50
Aluminum hydroxide as a phos binder?
- Increases plasma aluminum in patients with HD and PD
| - Aluminum is toxic at low concentrations - linked to dementia
51
Calcium based salts as a phos binders?
- Not to be used in hypercalcemia
| - Contributes to calcium deposit functions
52
Sevelamer (RENAGEL or RENVELA) as a phos binder?
- Safe due to low absorption
- Lowers LDL
- **Gi disturbances** do not use in bowel obstruction
53
Lanthanum (Phosrenol) as a phos binder?
- Lanthanum accumulation can become a problem
| - Expensive
54
____ is a clinical consequence of CKD
Anemia
55
What is anemia caused primarily by?
Decreased production of the EPO hormone in the kidney
56
Secondary causes of anemia?
- Residual blood loss in the dialyzer
- Inflammation due to infection and co-morbid conditions
- Hyperparathyroidism can be adjunctive cause
57
Treatment with anemia?
- Treat with EPO injections and adequate iron from IV dextran
- Return blood to patient as much as possible
- Treat hyperparathyroidism
- Avoid blood transfusions which may help prevent iron overload and antibody production which may prevent successful transplantation later
58
Why is constipation common in dialysis?
- Low fluid intake
- Inactivity
- Use of calcium containing phos binders
- F/V avoidance due to k content
- Low fibre food choices
59
What can severe constipation lead to?
Impaction and bowel perforation
60
How should we treat constipation?
- Add foods high in fiber content
- Increase fluid intake if possible
- Add fibre in form of psyllium hydrophillic mucilloid (Metamucil)
- Use stool softener (Docusate Sodium/Colace)
61
During dialysis, how is BP affected?
Causes hypotension
62
What does food ingestion during dialysis cause?
-Decreased constriction of resistance vessels in certain vascular beds, especially splanic beds - which can last for 2 hours
63
Guidelines regarding food ingestion and dialysis?
-Avoid food just before and during dialysis if prone to hypotension
64
Diabetics not prone to hypotension may eat what during dialysis?
- Low fat meal, or use small CHO snack food; fruit, crackers
| - Avoid a hypoglycemic episode
