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T2: CKD

Chapter 47: Chronic Kidney Disease

QuestionAnswer
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