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Flashcards in Renal Health maintenance Deck (24)
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1
Q

In renal failure pts preventive strategies usually focus on renal disease related issues of? Other general health issues?

A
  • anemia
  • mineral metabolism
  • HTN
  • vascular access for dialysis
  • other general health issues:
    vaccinations, cancer screening, control of DM, lipid management
2
Q

What acute issues take priority over general health issues?

A
  • infection
  • bleeding
  • malnutrition
  • volume overload
  • vascular thrombosis
  • unstable BP
  • with abnorm of immune fxn, pts with kidney disease are more susceptible to infection and malignancies
3
Q

Preventive strategies include?

A
  • infection screening
  • immunizations
  • lipid management
  • DM control
  • HTN management
  • cancer screening
  • smoking cessation
4
Q

Who should be screened for kidney disease according to the National Kidney Foundation?

A

pts with:
diabetes
HTN
family hx of kidney disease
older than 60
ethinic minorities: african americans, native americans, asians
- recommended that minimal screening include assessment of GFR (serum creatinine included) and proteinuria
- Microalbuminuria is now an essential component

5
Q

Who should be tested for urinary protein?

A
  • as part of the initial assessment: new HTN, hematuria, or decreased GFR, DM
  • as part of annual monitoring: bx proven GN, reflux nephropathy
  • as part of routine monitoring for pts receiving nephrotoxic agents
6
Q

What are the general signs you are looking for in a pt with suspected renal disease?

A
  • blood in urine
  • edema
  • fatigue
7
Q

Why is there such a high infection risk in renal pts? Where do this infections occur?

A
  • renal failure pts have immune insufficiency
  • hospitalization for infection are 3-4x worse in pts with CKD
  • other risks: bacterial infection - lungs, intestines, peritoneum, urinary tract, and skin, infections secondary to skin excoriations from pruritus, xerosis, and atrophy of sweat glands
  • common microorganisms are staph and E. coli
  • klebseilla is not uncommon in pts with CKD who are hosp for pulm infections
8
Q

Morbidity/mortality in renal failure pts because of infection?

A
  • sepsis in ESRD has mortality that is 100-300 fold higher than general pop
  • infective endocarditis can be fatal
  • UTI’s in anuria pts: pyocystitis can lead to sepsis
  • pulmonary infections: have 14-16 fold higher mortality rate
9
Q

Screening and prophylaxis for bacterial infections in renal failure pts?

A
  • examin skin
  • placement of AV fistulas before initiation of hemodialysis
  • screen for staph nasal colonization
  • consider use of mupirocin or gentamicin ointment to catheter exits
  • educate on dental evals
  • endocarditis prophylaxis (2 g amoxicillin or 600 mg clindamycin) 1 hr before invasive dental procedures
10
Q

What immunizations should renal failure pts have?

A
  • influenza: decrease chance of hospitalizations
  • pneumococcus: given to elderly and immunocompromised
    revaccination 5 years after initial vaccination
    can give titers every 2 years in ESRD when titers decrease below 200 micrograms/L
  • complication of arthrus-type reaction with frequency
  • hep A (0, 1, 6 months)
  • hep B (need surface Ag testing for HBV, and testing done before intiation of dialysis, seroconversion rates worsen as renal disease progresses, series of 3 injections 0,1-2, and 4-6 months
  • hep C: not a vaccine, still good to screen, increase seroconversion with pts on dialysis
    ESRD pts with Hep C must be tx before transplant d/t rejection
11
Q

Why is lipid management so impt in renal disease? What should be checked and how often?

A
  • risk of CVD is high
  • fasting LDL, HDL, TG and total cholesterol levels should be checked once a year for pts with CKD
  • should be set up with renal dietician
  • meds: statins (simvastatin 20 mg qday)
12
Q

Good glucose control?

A
  • progression of CV complications with poor glycemic control
  • HbA1C level should be controlled to belwo 7
  • HbA1C should be checked every 6 months, unless change in tx, then every 3 months until goal is reached
  • metformin should be avoided with creatinine above 1.5 in men nad 1.4 in women because of lactic acidosis
13
Q

Blood pressure control?

A
  • strict pressure control high priority
  • ACEI or ARBs are commonly used as initial meds
  • BP goal is less than 130/80, the NKF suggest BP be less than 125/75
  • tight BP control can halt progression of renal failure
14
Q

Why is tobacco cessation so impt? meds?

A
  • cigarette smoking is assoc with more rapid decline in renal failure
  • pt should be encouraged to stop cause of CV risk
  • meds:
    nicotine patch (21 mg, 14 mg, 7 mg), wellbutrin/bupropion, chantix (BBW: risk of suicide)
15
Q

Cancer screening in renal failure pts?

A
  • tumors of GU tract develop 4-5x more frequently than lung, colon, or breast
  • RCC
  • prostate cancer: 50 years and older with life expectancy of 10 yyears get annual DRE and PSA
  • pts at high risk at 40 with DRE and PSA (only if on transplant list) get screened
  • colorectal screening: colonoscopy at age 50 and repeat every 10 years if initial was negative, annual fecal occult blood test, flexible sigmoidoscopy every 5 years
  • breast cancer: high risk pts whose life expectancy is 5 years
    screening mammograms for women older than 50, and women older than 40 that are on the transplant list
    both groups do SBEs
  • cervical cancer: high risk pts with life expectancy of 5 years or more, screening pap smears at age 21, HPV DNA testing and HPV vaccine in transplant pts, yearly pap test for those on transplant list
16
Q

What should an screening for anemia include?

A
  • CBC
  • retic count
  • serum ferritin
  • transferrin saturation (TSAT)
  • hemoglobin target should be 11-12 g/L
17
Q

What should a workup of bone metabolism include?

A
  • intact PTH
  • phosphorus
  • calcium
    should limit dietary phosphorus to 800-1000 mg a day, use phosphate binders (inhibit absorbtion in GI tract)
18
Q

When should screening for urinary protein be done in an initial assessment?

A
  • in new HTN, hematuria, or decreased GFR
  • unexplained edema
  • suspected multi-system disease (SLE, vasculitis), DM
19
Q

Urinary protein should be a part of annual monitoring in pts with?

A
  • bx proven GN
  • reflux nephropathy
  • urological unexplained hematuria or proteinuri
20
Q

What is microalbuminuria a sign of and what is it assoc with?

A
  • first sign of diabetic nephropathy and assoc with poor glycemic control and elevated BP
21
Q

What meds should you avoid or be cautious with in renal disease?

A
  • avoid NSAIDs
  • abx be careful:
    PCNs
    cephalosporins
    sulfonamides
    fluoroquinolones:
    levoquin, cipro, gemifloxacin
  • magnesium containing meds: laxatives and antacids (tums)
22
Q

At what GFR should you refer to nephro?

A
  • under 15: immediate referral
  • 15-29: urgent referral (routine if known to be stable)
  • 30-59: routine referral
  • 60-89: referral not reqd unless high risk issues present
23
Q

Good pt information to know?

A
  • complete medical hx
  • urinary sxs (obstructed)
  • meds: NSAIDs, nephrotoxic meds
  • exam findings
  • labs: UA,CBC, CMP, phosphorus, lipids, HgA1C, SCr
  • renal U/S
24
Q

keys to help stop progression of kidney disease?

A
  • exercise regularly
  • don’t overuse OTC painkillers, NSAIDs, or nephrotoxic drugs
  • control wt
  • get annual physical
  • healthy diet
  • know family’s medical hx
  • monitor BP and cholesterol
  • education about kidney disease
  • don’t smoke or abuse alcohol