urologic problems: chronic kidney disease

Question 1

kidney function

Answer 1

-maintain fluid and electrolyte homeostasis
-rid the body of water soluble wastes via urine
-endocrine fxns:
*produces erythropoietin
*activates vit D
*produces renin (helps regulate BP)

Question 2

RAAS system

Answer 2

1. renin converts angiotensinogen to angiotensin I
2. ACE converts angiotensin I to angiotensin II
3. angiotensin II –> aldosterone

blood pressure regulation
- blood volume
- sodium reabsorption
- potassium secretion
- water reabsorption

Question 3

BUN and Cr lab values

Answer 3

BUN = 10-20 mg/dL
Cr = 0.5-1.2 mg/dL

BUN:Cr = 10:1

Question 4

GFR lab value

Answer 4

> 90 mL/min

Question 5

when would you see a 20:1 BUN:Cr ratio?

Answer 5

glomerulonephritis and nephrotic syndrome

Question 6

chronic kidney disease (CKD)

Answer 6

presence of kidney damage for > 3 months with/without GFR <60

-inability to maintain acid-base balance, remove end products of metabolism (build up of toxins), maintain fluid/electrolyte balance

Question 7

CKD stage 1

Answer 7

kidney damage with normal or increased GFR

greater than or equal to 90

Question 8

CKD stage 2

Answer 8

kidney damage with mild decrease in GFR

60-89

Question 9

CKD stage 3

Answer 9

moderate decrease in GFR

30-59

Question 10

CKD stage 4

Answer 10

severe decrease in GFR

15-29

Question 11

CKD stage 5

Answer 11

ESRD

<15

Question 12

causes of ESRD

Answer 12

diabetes (50%)
HTN (30%)
glomerulonephritis (10%)
other (10%)

Question 13

risk factors for CKD

Answer 13

family history
>60
male
african american
HTN, DM
smoking
overweight/obesity

Question 14

3 characteristics of CKD

Answer 14

1. glomerulosclerosis: scar tissue in glomerulus – can’t filter blood properly (nonfunctional fibrotic tissue)
2. interstitial fibrosis: obstruction of renal tubules and interstitial capillaries
3. interstitial inflammation

Question 15

what plays a major role in CKD

Answer 15

complement - part of inflammatory process that destroys kidney tissue

angiotensin II - an increase causes increased BP, thus increased damage

Question 16

S/S stage 1 CKD

Answer 16

asymptomatic

Question 17

S/S stage 2 CKD

Answer 17

asymptomatic, possible HTN

Question 18

S/S stage 3 CKD

Answer 18

asymptomatic, possible HTN

Question 19

S/S stage 4 CKD

Answer 19

manifestations becoming apparent
*diagnosis often occurs here

Question 20

S/S stage 5 CKD

Answer 20

uremia
GFR < 15

Question 21

uremia

Answer 21

high levels of waste in blood

-BUN
-Cr
-phenols
-hormones
-electrolytes
-water (retained)

seen when GFR < 10

Question 22

psychologic/neurologic S/S of ESRD

Answer 22

anxiety and depression
fatigue
headache
sleep disturbances
encephalopathy
paresthesia
restless legs syndrome

Question 23

cardiovascular S/S of ESRD

Answer 23

HTN
heart failure
CAD
pericarditis
peripheral artery disease

Question 24

GI S/S of ESRD

Answer 24

anorexia
N/V
GI bleeding
gastritis

Question 25

pulmonary S/S of ESRD

Answer 25

PE uremic pleuritis pneumonia

Question 26

ocular S/S of ESRD

Answer 26

HTN retinopathy

Question 27

endocrine S/S of ESRD

Answer 27

hyperparathyroidism thyroid abnormalities amenorrhea erectile dysfunction

Question 28

metabolic S/S of ESRD

Answer 28

carb intolerance HLD

Question 29

hematologic S/S of ESRD

Answer 29

anemia bleeding infection

Question 30

integumentary S/S of ESRD

Answer 30

pruritus ecchymosis dry, scaly skin

Question 31

MSK S/S of ESRD

Answer 31

vascular and soft tissue calcifications (hardness causing soreness) osteomalacia (softening of bones bc decrease in Vit D) osteitis fibrosa (loss of bone mass)

Question 32

abnormal kidney functions

Answer 32

-no longer maintain F/E homeostatis -no longer rids the body of wastes via urine -decreased production of erythropoietin -decreased activation of vitamin D

Question 33

unable to maintain f/e homeostasis results in

Answer 33

edema high potassium high phos high mag metabolic acidosis

Question 34

unable to rid body of wastes results in

Answer 34

anorexia malnutrition itching CNS changes *uremic frost (crystallized deposits on skin - white spots)

Question 35

decreased production of erythropoietin results in

Answer 35

anemia

Question 36

decreased activation of vit D results in

Answer 36

renal osteodystrophy (weakening of bones)

Question 37

drugs can be used to

Answer 37

slow the rate of progression by decreasing BP < 140/90 and treating HLD <200 (cholesterol) & treat complications of CKD

Question 38

complications of CKD

Answer 38

volume overload hyperkalemia metabolic acidosis hyperphosphatemia renal osteodystrophy anemia

Question 39

how to control BP

Answer 39

ACE or ARB maintain SBP 110-130

Question 40

how to control lipids

Answer 40

statins

Question 41

treatment for volume overload

Answer 41

loop diuretic used with low salt diet

Question 42

treatment for hyperkalemia

Answer 42

multiple -- diuretics addressed with hemodialysis in ESRD

Question 43

treatment for metabolic acidosis

Answer 43

sodium bicarbonate *alkaline agent

Question 44

treatment for hyperphosphatemia

Answer 44

calcium carbonate a phosphate binder

Question 45

treatment for renal osteodystrophy

Answer 45

calcitrol activated vitamin D

Question 46

treatment for anemia

Answer 46

erythropoietin *must have iron BLACK BOX WARNING: increase CV problems

Question 47

goal of sodium bicarbonate

Answer 47

metabolic acidosis goal: slow CKD progression, prevent bone loss, improve nutritional status

Question 48

administration of sodium bicarbonate

Answer 48

initiate when HCO3 <15 (tested with CO2 on BMP titrate to a HCO3 of 18-20 consider switch to sodium citrate if bloating is a problem

Question 49

calcium carbonate MOA + goal

Answer 49

MOA: binds to phosphate GOAL: treat hyperphosphatemia -keep phosphate levels normal (near) -reduce mortality

Question 50

considerations + SE's with calcium carbonate

Answer 50

take with meals to increase absorption SE: high Ca --> monitor levels (acts as sedative)

Question 51

calcitriol MOA

Answer 51

activated form of vit D stimulates intestinal absorption of calcium/phosphate and bone mineralization

Question 52

calcitriol SE

Answer 52

high Ca - toxicity high phosphate

Question 53

signs of Ca toxicity

Answer 53

GI upset bone pain neuro effects cardiac arrythmias

Question 54

complications of drug therapy

Answer 54

many drugs are excreted through kidneys, so if the kidneys are functioning may need to have renal dosing (decreased dose + frequency)

Question 55

drugs of concern when treating CKD

Answer 55

digoxin diabetic agents (glyburide, metformin) antibiotics (vancomycin) opioids (morphine)