Chronic Kidney Dz Flashcards
Chronic Kidney Disease (CKD)- End Stage Renal Disease (ESRD)
Patients remain asymptomatic until their disease has significantly progressed, true or false?
True
Common causes of late-stage chronic kidney disease
most are due to DM and HTN
Some are unknown or due to other causes
CKD
Definition
-GFR less than 60 mL/min for greater than or equal to 3 months with or without kidney damage
OR
-Kidney damage for greater than or equal to 3 months with or without decreased GFR
CKD
disease progression
- CKD is rarely reversible and leads to a progressive decline in renal function
- reduction in renal mass leads to hypertrophy if the remaining nephrons
- this places a burden on the remaining nephrons and leads to progressive glomerular sclerosis and interstitial fibrosis
CKD
Risk factors
- DM
- HTN
- older age
- FHx
- drug toxicity
- urinary obstruction
- african american
- american indian
- asian
- pacific islander
How many nephrons does each kidney contain?
What are the consequences of destruction of the nephrons?
At what GFR % decrease do blood urea and Cr start to show a measurable increase?
Plasma Cr value will approximately double with a ____% reduction in GFR
How many nephrons does each kidney contain?
-1 million
What are the consequences of destruction of the nephrons?
-hyperfiltration and compensatory hypertrophy
At what GFR % decrease do blood urea and Cr start to show a measurable increase?
-Only after GFR has decreased by 50%
Plasma Cr value will approximately double with a _50__% reduction in GFR
What five steps are taken during the initial assessment of CKD?
- Confirm primary renal dx
- Establish chronicity
- Identify reversible factors
- Detect co-morbid factors
- Establish a baseline database
What are the five stages of CKD?
At which stages do symptoms appear?
Stage 1: Kidney damage with normal or increased GFR (greater than 90 mL/min)
Stage 2: Mild reduction in GFR (60-89 mL/min)
Stage 3: Moderate reduction in GFR (30-59 mL/min)
Stage 4: Severe reduction of GFR (15-29 mL/min)
Stage 5: Kidney failure (GFR less than 15 mL/min or dialysis)
*sx typically appear in stages 4 and 5, 1-3 are frequently asymptomatic
How do you measure renal function?
Serum Creatinine
- it will increase as renal function worsens
- alone, SCr is not an accurate measurement of GFR
The national kidney foundation advises that what two testes be used together to improve prognostic accuracy?
GFR and Albuminuria
**Microalbuminuria is a key parameter for measuring nephron injury and repair (its an early sign of kidney disease)
What is Azotemia?
What are the types?
What can Azotemia lead to?
What is Azotemia?
-condition characterized by high levels of nitrogen-containing compounds in the blood
What are the types?
- Prerenal azotemia
- Primary renal azotemia
- Postrenal azotemia
What can Azotemia lead to?
-If not treated, can lead to Uremia
What is Uremia?
When do sx occur?
What is Uremia?
-condition resulting from advanced stages of kidney failure in which urea and other nitrogen containing wastes are found in the blood
When do sx occur?
-sx may not occur until 90% of the nephrons are destroyed
Uremia
sx
signs
labs
sx: fatigue, weakness, easy bruising, breath “fishy odor”, metallic taste in mouth, epistaxis, dyspnea, pulm edema, pericarditis, anorexia/n/v, ED, amenorrhea, restless legs, numbness, cramps, irritability
signs: Sallow (unhealthy) appearing, pallor, ecchymosis, excoriations, edema, yellow, urinous breath, pale conjunctiva, rales, pleural effusion, HTN, cardiomegaly, friction rub, stupor, asterixis ( tremor of the hand when the wrist is extended), peripheral neuropathy
labs:
- BUN/Cr: elevated
- CBC: anemia
- CMP: hyperphosphatemia, hyperkalemia, hypocalcemia
- Serum albumin levels: low (spilling into urine)
- lipid profile: risk of CVD
- Urinalysis: broad waxy cast cells
- also look for evidence of renal bone disease by serum phosphate, Vit D, alkaline phosphatase, intact PTH levels
Uremia
imaging
complications
Imaging:
- renal ultrasound (small echogenic kidney bilaterally
- CT
- MRI/MRA
- Retrograde pyelogram
- renal bx (indicated when real impairment is present and the dx is unclear after extensive work-up
Complications
- Hyperkalemia (especially when GFR drops below 10 mL/min, kidneys have a decreased ability to secrete potassium)
- metabolic acidosis (damaged kidneys are unable to excrete the 1 mEq/kg/day of acid generated by metabolism of dietary proteins, this limits the production of ammonia and limits buffering of H+ in the urine…excess H+ are buffered by large calcium carbonate and calcium phosphate stores in the bone…this contributes to renal osteodystrophy of CKD)
(more) Complications of CKD
CV
Hematologic
Neurologic
CV
-HTN, pericarditis, CHF, pulmonary edema, Heart disease (LVH and Ischemic heart disease)
Hematologic
- Anemia (normochromic, normocytic), due to decreased EPO production
- Coagulopathy (d/t platelet dysfunction, abnormal adhesiveness and aggregation)
Neurologic
- uremic encephalopathy
- peripheral neuropathy (stocking glove distribution)
- Sub-arachnoid hemorrhage
