RENAL FAILURE Flashcards
(27 cards)
acute renal failure
clinical conditions assoc with rapid (days to weeks), steadily decreasing renal function (azotemia) with or without oliguria
acute renal failure causes
- hemorrhage
- cardiomyopathy
- septicemia
- liver failure
- surgery
- malignant HTN
- glomerulonephritis
- bacterial infx
- metabolic d/o (hypercalcemia, hyperuricemia)
acute renal failure
- drug induced causes
- NSAIDS
- abx
- amphotericin
- foscavir
- digoxin
- cyclosporine
- methotrexate
- cisplatin
- radiocontrast dye
acute renal failure prevention
- with surgery, burns, hemorrhage, nephrotoxic drugs
- w/surgery: maintain nl fluid balance, blood volume, and BP
- w/burns: isotonic NaCl infusion
- w/hemorrhage: blood transfusion
- w/nephrotoxic drugs: hydration, n-acetylcysteine, proper monitoring
acute renal failure tx
- list names
- vasopressors (dopamine)
- diuretics (furosemide, mannitol)
- electrolytes
- IV calcium for cardiac tox
- dextrose and insulin
- dialysis
ARF
- dopamine effect (vasopressor)
- inc renal blood flow and urine output
- use lower doses for IV infusions
ARF
- dextrose and insulin units
10 units of insulin for every 50 ml of 50% dextrose
ARF
- dialysis effects
- caution
- improves fluid and electolyte imbalances
- allows adequate nutrition
caution
- DO NOT use in uncomplicated ARF (<5 days duration)
- may need to adjust doses of ll renally eliminated drugs
chronic renal failure
- define
- MCC ESRD
clinical condition resulting from chronic derangement and insufficiency of renal excretory and regulatory function
- MCC of ESRD is diabetic nephropathy
chronic renal failure causes
can result from any major caue of renal dysfunc
- diabetic nephropathy (MCC)
- glomerulopathies
- hereditary nephropathies (polycystic kidney ds)
- HTN
- obstructive uropathies
chronic renal failure
- exacerbating factors
- nephrotoxic drugs
- sodium and water depletion
- HF
- infx
- hypercalcemia
- obstruction
CRF management approaches
- delay progression (like w/DM)
- diet
- maintain fluid and electrolyte balance
CRF management
- delaying progression
- glycemic control
- lipid control
- HTN control
- reduce protein intake
- ACEi
CRF management
- diet
- mixed protein diet
- inc calories if anorexic
- vitamin supplementation w water soluble vitamins
CRF management
maintain fluid and electrolyte balance
- hyperkalemia
hyperkalemia
- sodium polystyrene sulfonate: inc fecal excretion K+, orally and rectally admin, acts on colon (enema preferred), can be used in emergency if pt can retain for 60 min
- patiromer: inc fecal K+ excretion by binding K+ in lumen & exchanging for calcium
- sodium zirconium cyclosilicate: reduce free K+ in lumen of GI and lowers serum K+ by exchange K+ for H+ and Na+
polystyrene–> bind and excrete K
patiromer–> bind, exchange for calcium, excrete K
zirconium–> bind, exchange for hydrogen and sodium, excrete K
CRF management
maintain fluid and electrolyte balance
- hyperphosphatemia
tx w/dietary restriction of phosphate and phosphate binders
- calcium salts
- aluminum salts
- sevelamar
- lanthanum carbonate
CRF management
hyperphosphatemia tx
- calcium salts
- aluminum salts
calcium salts
- acetate
- carbonate
aluminum salts
- hydroxide
CRF management
hyperphosphatemia
- sevelamar
- pros and cons, other benefits
- non electrolyte synthetic binder
- LESS ADRs than electrolyte binders (milder GI effects)
- may also lower cholesterol
- noncompliance due to high pill burden and cost
CRF management
hyperphosphatemia tx
- lanthanum carbonate
as effective as calcium binders w out side effects associated w high dose calcium
- newer drug
- high affinity for phosphate
CRF management
- metabolic acidosis
- cardiac tox
metabolic acidosis
- use sodium bicarb
cardiac tox
- use IV calcium (CaCl or Ca Gluconate)
tx for anemia
- MOA
- monitoring
EPO alfa and iron
- MOA: erythrocyte colony stimulating factor–> increases maturation of RBC from bone marrow
- monitor: HCT (hematocrit), iron stores
tx hyperparathyroidism (secondary to renal insuff)
- vit D analogs to lower PTH and avoid bone ds
- calcium salts
- phosphate binders
- cincalcet
- dialysis and renal transplant
dialysis definition
directly removing toxins from blood (hemodialysis) or indirectly via peritoneal fluid (peritoneal dialysis) using diffusion across a semipermeable membrane or ultrafiltration
indications for dialysis
- ARF due to acute tubular necrosis (use until BUN+creatinine nl)
- CRF (once CRCL <10 or pt cant maintain nl ADLs)
- uremic encephalopathy
- pericarditis
- fluid overload
- life threatening hyperkalemia
- acute intox
