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T2: CKD
Chapter 47: Chronic Kidney Disease
| Question | Answer |
|---|---|
| The presence of kidney damage or a decreased GFR <60 mL/min for longer than 3 months and is progressive, irreversible loss of kidney function. | Chronic kidney disease (CKD) |
| What are some markers of kidney damage? | blood, urine, imaging tests |
| Normal GFR | 125 mL/min; is reflected by urine creatinine clearance |
| End stage kidney disease (ESKD) occurs when? | GFR <15 mL/min |
| Stage 1 of CKD | Kidney damage w/normal or increased GFR >=90 |
| Stage 2 of CKD | Kidney damage w/mild decreased GFR of 60-89 |
| Stage 3 of CKD | Moderate decreased GFR of 30-59 |
| Stage 4 of CKD | Severe decreased GFR of 15-29 |
| Stage 5 of CKD | Kidney failure <15 (or dialysis) |
| Stage 1 Clinical Action Plan | Diagnosis and treatment CVD risk reduction. Slow progression. |
| Stage 2 Clinical Action Plan | Estimation of progression. |
| Stage 3 Clinical Action Plan | Evaluation and treatment of complications. |
| Stage 4 Clinical Action Plan | Preparation for renal replacement therapy (dialysis, kidney transplant) |
| Stage 5 Clinical Action Plan | Renal replacement therapy (if uremia present & patient desires treatment) |
| Because the kidneys are highly adaptive, kidney disease is often not recognized until there has been considerable loss of nephrons. What happens to the remaining nephrons? | Remaining nephrons hypertrophy to compensate. |
| What is the end result of CKD? | a systemic disease involving every organ |
| What are the leading causes of ESKD? | diabetes and HTN |
| The clinical manifestations are a result of retained substances such as? | urea, creatinine, phenols, hormones, electrolytes, water, other substances |
| Syndrome that incorporates all signs and symptoms seen in various systems throughout the body. Often occurs when the GFR is 10 mL/min or lower. | uremia |
| What are some possible clinical manifestations of CKD? | anxiety, depression, HTN, HF, CAD, PAD, pericarditis, anorexia, N/V, GI bleed, gastritis, thyroid abnorm, amenorrhea, ED, carb intolerance, hyperlipidemia, anemia, infection, fatigue, headache, pulm. edema, pneumonia, pruritus, ecchymosis, dry, scaly skin |
| Polyuria occurs most often at night and has a specific gravity fixed around 1.010. What causes polyuria in CKD? | inability of kidneys to concentrate urine |
| This occurs as CKD worsens. | oliguria |
| Urine output lower than 40 mL/24 hrs. | anuria |
| These are considered more accurate indicators of kidney function than BUN or creatinine values. | serum creatinine clearance determinations (calculated GFR) |
| In CKD, as GFR decreases, what do BUN and serum creatinine levels do? | increase |
| What are some things that can cause BUN levels to increase? | kidney failure, protein intake, fever, corticosteroids, and catabolism |
| What s/s can occur with increased BUN levels? | N/V, lethargy, fatigue, impaired though processes, and headaches |
| What are some metabolic disturbances associated with CKD? | waste product accumulation, altered carbohydrate metabolism, defective carbohydrate metabolism, elevated triglyceride levels |
| Altered carbohydrate metabolism and defective carbohydrate metabolism is caused by what? | impaired glucose metabolism from cellular insensitivity to normal action of insulin |
| Patients with diabetes who develop uremia may require what? | less insulin after onset of CKD |
| A number of patients on dialysis who required insulin before starting dialysis will be able to do what as kidney disease progresses? | discontinue insulin therapy |
| Almost all patients with uremia develop this. | dyslipidemia |
| Explain what the VLDLs, LDLs, and HDLs levels are in CKD? | elevated levels of VLDLs, normal or decreased levels of LDLs, and decreased levels of HDLs |
| Elevated glucose levels lead to increased insulin levels, and insulin stimulates what? | hepatic production of triglycerides |
| Most patients with CKD die from what? | cardiovascular disease |
| Most serious electrolyte disorder in kidney disease. Why? | potassium can cause fatal dysrhythmias |
| Fatal dysrhythmias can occur when the serum potassium level reaches what? | 7-8 mEq/L |
| What causes hyperkalemia in CKD? | Decreased excretion of potassium by the kidneys, the breakdown of cellular protein, bleeding, and metabolic acidosis. Potassium may also come from the food consumed, dietary supplements, drugs, & IV infusions. |
| If large quantities of water are retained, this can occur. | dilutional hyponatremia |
| Sodium retention can contribute to what? | edema, HTN, & HF |
| Sodium restriction is usually restricted to? | 2g/day |
| Hypermagnesemia is generally not a problem unless? | the patient is ingesting magnesium (e.g. milk of magnesia, magnesium citrate, antacids containing magnesium) |
| What are some of the clinical manifestations of hypermagnesemia? | absence of reflexes, decreased mental status, cardiac dysrhthmias, hypotension, and respiratory failure |
| What causes metabolic acidosis in CKD? | The inability of kidneys to excrete acid load (primary ammonia) and defective reabsorption/regeneration of bicarbonate. |
| How much acid the the average adult produce per day? This acid is normally buffered by what? | 80-90 mEq/day, bicarbonate |
| Plasma bicarbonate level is an indirect measure of what? | acidosis |
| In kidney failure, plasma bicarb levels usually fall to a new steady state at approximately? | 16-20 mEq |
| What is the cause of anemia in CKD? | Due to decreased production of erythropoietin from decreased functioning of renal tubular cells, nutritional deficiencies, decreased RBC life span, increased hemolysis of RBCs, frequent blood sampling, & GI bleeds. |
| Bleeding tendencies are caused by what? | Defect in platelet function that is caused by impaired platelet aggregation and impaired release of platelet factor III. |
| What factors contribute to the increased risk of infection in CKD? | Changes in WBC function, altered immune response and function, diminished inflammatory response, hyperglycemia, and external trauma (e.g. catheters, needle insertions into vascular sites). |
| The most common cause of death in patients with CKD is? | cardiovascular disease |
| What are some leading causes of death? | MI, ischemic heart disease, PAD, HF, cardiomyopathy, and stroke |
| Even a slight reduction in GFR has been associated with a higher risk for development of what? | CAD |
| What are some cardiovascular clinical manifestations in CKD? | HTN, HF, left ventricular hypertrophy, peripheral edema, dysrhythmias, uremic pericarditis |
| What are some respiratory clinical manifestations in CKD? | Kussmaul respirations, dyspnea may occur with fluid overload, pulmonary edema, uremic pleuritis, respiratory infections |
| With severe acidosis, how does respiratory attempt to compensate? | With Kussmaul breathing, which results in increased carbon dioxide removal by exhalation. |
| Every part of the GI system is affected in CKD. Why? | due to excessive urea |
| These are commonly found in CKD. | stomatitis with exudates & ulcerations, a metallic taste in teh mouth, and uremic fetor (a urinous odor of the breath) |
| These may develop if CKD progresses to ESKD and is not treated with dialysis. | anorexia, nausea, and vomiting |
| GI bleeding is also a risk because of what? | mucosal irritation and the platelet defect |
| Constipation may be due to what? | The ingestion of iron salts and/or calcium containing phosphate binders. |
| The central nervous system becomes depressed resulting in what? | lethargy, apathy, decreased ability to concentrate, fatigue, irritability, and altered mental ability |
| These may result from a rapidly increasing BUN level and hypertensive encephalopathy. | seizures and coma |
| What are some neurologic clinical manifestations in CKD? | Restless legs syndrom (RLS), muscle twitching, irritability, decreased ability to concentrate, peripheral neuropathy, altered mental ability, seizures, coma, dialysis encephalopathy |
| What causes neurologic changes in CKD? | Increased nitrogenous waste products, electrolyte imbalances, metabolic acidosis, atrophy, and demyelination of nerve fibers. |
| Peripheral neuropathy is initially manifested by what? | A slowing of nerve conduction to the extremities. |
| Individuals with advanced stage 5 CKD may complain of this. | Restless leg syndrome; described as feeling as if "bugs are crawling inside the leg." |
| The treatment for neurologic problems is what? | Dialysis or kidney transplant. |
| This is a late manifestation of CKD stage 5 and is rarely seen unless the patient has chosen to forgo RRT. | altered mental status |
Created by:
eblanc1
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