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Chronic kidney disease gk

Chronic kidney disease gk






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    Chronic kidney disease gk Chronic kidney disease gk Presentation Transcript

    • Chronic Kidney Disease
    • Anatomy 2 Kidneys 2 Ureters Bladder Urethra
    • Kidney Function Detoxify blood Increase calcium absorption  calcitriol Stimulate RBC production  erythropoietin Regulate blood pressure and electrolyte balance  renin
    • Classifications Acute versus chronic Pre-renal, renal, post-renal Anuric, oliguric, polyuric
    • Acute Versus Chronic Acute  sudden onset  rapid reduction in urine output  Usually reversible  Tubular cell death and regeneration Chronic  Progressive  Not reversible  Nephron loss 75% of function can be lost before its noticeable
    • Acute Renal Failure Pre-renal = 55% Renal parenchymal (intrinsic)= 40% Post-renal = 5-15%
    • Causes of ARF Pre-renal =  vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure  cardiac failure, liver dysfunction, or septic shock Intrinsic  Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins Post-renal =  prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders  neurogenic bladder  bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and fungus
    • Symptoms of ARF Decrease urine output (70%) Edema, esp. lower extremity Mental changes Heart failure Nausea, vomiting Pruritus Anemia Tachypenic Cool, pale, moist skin
    • Acute Renal FailureManagement Make/think about the diagnosis Treat life threatening conditions Identify the cause if possible  Hypovolemia  Toxic agents (drugs, myoglobin)  Obstruction Treat reversible elements  Hydrate  Remove drug  Relieve obstruction
    • Hyperkalemia Symptoms Weakness Lethargy Muscle cramps Paresthesias Hypoactive DTRs Dysrhythmias
    • Hyperkalemia & EKG K > 5.5 -6 Tall, peaked T’s Wide QRS Prolong PR Diminished P Prolonged QT QRS-T merge – sine wave
    • Hyperkalemia Treatment Calcium gluconate (carbonate) Sodium Bicarbonate Insulin/glucose Kayexalate Lasix Albuterol Hemodialysis
    • Chronic Kidney DiseaseChronic kidney disease (CKD)encompasses a spectrum ofdifferent pathophysiologicprocesses associated withabnormal kidney function and aprogressive decline in glomerularfiltration rate (GFR).
    • Recommended Equations for Estimation ofGlomerular Filtration Rate (GFR) Using SerumCreatinine Concentration (PCr), Age, Sex, Race, andBody Weight1. Equation from the Modification of Diet in RenalDisease study*Estimated GFR (mL/min per 1.73 m2) = 1.86 x(PCr)–1.154 x (age)–0. 203Multiply by 0.742 for womenMultiply by 1.21 for African Americans2. Cockcroft-Gault equationEstimated creatinine clearance (mL/min)= (140–age) x body weight (kg) 72 x PCr (mg/dL)Multiply by 0.85 for women
    • Leading Categories ofEtiologies of CKD Diabetic glomerular disease Glomerulonephritis Hypertensive nephropathy Primary glomerulopathy with hypertension Vascular and ischemic renal disease Autosomal dominant polycystic kidney disease Other cystic and tubulointerstitial nephropathy
    • CRF Symptoms Malaise  Seizure Weakness  Constipation Fatigue  Peptic ulceration Neuropathy  Diverticulosis  Anemia CHF  Pruritus Anorexia  Jaundice Nausea  Abnormal Vomiting hemostasis
    • Causes of Anemia in CKD Relative deficiency of erythropoietin Diminished red blood cell survival Bleeding diathesis Iron deficiency Hyperparathyroidism/bone marrow fibrosis "Chronic inflammation" Folate or vitamin B12 deficiency Hemoglobinopathy Comorbid conditions: hypo/hyperthyroidism, pregnancy, HIV-associated disease, autoimmune disease, immunosuppressive drugs
    • Problems Related to ESRD Metabolic – K/Ca Volume overload Anemia, platelet disorder, GI bleed HTN, pericarditis Peripheral neuropathy, dialysis dementia Abnormal immune function
    • Dialysis ½ of patients with CRF eventually require dialysis Diffuse harmful waste out of body Control BP Keep safe level of chemicals in body 2 types  Hemodialysis  Peritoneal dialysis
    • Hemodialysis 3-4 times a week Takes 2-4 hours Machine filters blood and returns it to body
    • Types of Access Temporary site AV fistula  Surgeon constructs by combining an artery and a vein  3 to 6 months to mature AV graft  Man-made tube inserted by a surgeon to connect artery and vein  2 to 6 weeks to mature
    • Access Problems AV graft thrombosis AV fistula or graft bleeding AV graft infection Steal Phenomenon  Early post-op  Ischemic distally  Apply small amount of pressure to reverse symptoms
    • Peritoneal Dialysis Abdominal lining filters blood 3 types  Continuous ambulatory  Continuous cyclical  Intermittent
    • EMS Considerations Make sure the dressing remains intact Do not push or pull on the catheter Do not disconnect any of the catheters Always transport the patient and bags/catheters as one piece Never inject anything into catheter
    • Dialysis Related Problems Lightheaded –give fluids Hypotension Dysrhythmias Disequilibration Syndrome  At end of early sessions  Confusion, tremor, seizure  Due to decrease concentration of blood versus brain leading to cerebral edema
    • Patient EducationSocial, psychological, and physical preparation for the transition to renalreplacement therapy and the choice of the optimal initial modality are bestaccomplished with a gradual approach involving a multidisciplinary team.Along with conservative measures discussed in the sections above, it isimportant to prepare patients with an intensive educational program,explaining the likelihood and timing of initiation of renal replacement therapyand the various forms of therapy available. The more knowledgeable thatpatients are about hemodialysis (both in-center and home-based), peritonealdialysis, and kidney transplantation, the easier and more appropriate will betheir decisions. Patients who are provided with educational programs aremore likely to choose home-based dialysis therapy. This approach is ofsocietal benefit because home-based therapy is less expensive and isassociated with improved quality of life. The educational programs should becommenced no later than stage 4 CKD so that the patient has sufficient timeand cognitive function to learn the important concepts, to make informedchoices, and implement preparatory measures for renal replacementtherapy.