Defined as:
decreased kidney function or kidney damage of ______ mnths’ duration based on blood tests, urinalysis, and imaging studies
3 or more
Also defined as:
GFR< ___ml/minute/__m2 for 3 mnths with or without indication of damage to the kidney
GFR< 60ml/minute/ 1.73 m2
Risk factors
- DM
- Hypertension
- Recurrent pyelonephritis
- Glomerulonephritis
- Polycystic kidney disease
- Family history of CKD
- History of exposure to toxins
- Age > 65
- Ethnicity
G5 stage: GFR is ____
Term: ______
<15 mL/min/1.73m2;
kidney failure
A3 stage: AER is ____
Term:
> 300 mg/day;
severely increased albuminuria
In stage 4 (15-29 GFR) of KD:
plan for ____________
dialysis or transplant
In stage 5: ____________ needed
renal replacement therapy
Complications of CKD (pt.1)
- hypertension, CVD– ______
- uraemic syndrome– retention of ______; could manifest as impaired healing, pruritus, dermatitis, ______
- ____________– retention of acidic waste products; kidneys lose ability to secrete ______ ions and ______
- electrolyte imbalances– retained potassium (______) , phosphorus, Mg
- hypertension, CVD– hypervolemia
- uraemic syndrome– retention of metabolic wastes; could manifest as impaired healing, pruritus, dermatitis, uraemic frost
- metabolic acidosis– retention of acidic waste products; kidneys lose ability to secrete H+ ions and bicarbonate
- electrolyte imbalances– retained potassium (hyperkalemia) , phosphorus, Mg
Complications of CKD (pt.2)
- bone and mineral disorders– elevated ______ and PTH causes altered bone/mineral metabolism; kidneys unable to reabsorb ______
- ______– decreased intake from uraemic syndrome, depression, dietary limitations, changes in taste, protein-energy wasting; negative nitrogen balance
- anaemia– lack of ______; uremia shortens RBCs life; cardiorenal anemia syndrome
- pain
- depression
- bone and mineral disorders– elevated phosphorus and PTH causes altered bone/mineral metabolism; kidneys unable to reabsorb calcium
- malnutrition– decreased intake from uraemic syndrome, depression, dietary limitations, changes in taste, protein-energy wasting; negative nitrogen balance
- anaemia– lack of erythropoietin; uremia shortens RBCs life; cardiorenal anemia syndrome
- pain
- depression
For mild metabolic acidosis, usually dont require any therapy.
For chronic metabolic acidosis, is ___pH and give _____
7.3;
sodium bicarbonate
Hyperkalemia can be detrimental as it can result in _______.
More than >6mmol/l of potassium: need ______
cardiac dysrhythmias;
urgent treatment
Primary management
- appropriate management of ____________
- ____________ in diabetes
- drugs: ____________ or ____________to reduce proteinuria
- aggressive management of ____________
- appropriate management of intrinsic/intra-renal (ATN)
- blood glucose control in diabetes
- drugs: ACE inhibitors or angiotensin II blockers to reduce proteinuria
- aggressive management of hypertension
BP goal
<130/80 mmHg
Fluid restrictions if sodium is
<135mmol/L
If oedema/ heart failure/ hypertension: may need __/day sodium restriction
2g/day
If potassium levels > 6mmol/L, give:
- IV calcium gluconate
- D5W (Dextrose 5% in water in IV)
- insulin
- oral/ rectum sodium polystyrene sulfonate
If hypocalcemia, give:
- calcium carbonate
- calcium acetate
- lanthanum carbonate
To suppress PTH, give:
- vit. D
- calcimimetics
Diet requirements
- increase _______, _______, _______
- adequate _______ & _______
- limit _______, _______, _______, _______, _______
- limit things that cld increase _______ risk
- increase calories, vitamins, calcium
- adequate carbo & fat
- limit phosphorus, protein, sodium, potassium, water/fluids
- limit things that cld increase cardio risk
Hgb level goal
11-12g/dL
To manage anaemia, give:
erythropoiesis-stimulating agents (ESA) like epoetin alfa
__________:
- artificial kidney serves as the dialyzing semi-permeable membrane
- access: AV fistula
- 3x/wk; each sesh 4hs
Haemodialysis
__________:
- limited to in-hosp AKI pts
- continuous haemofiltration
continuous renal replacement therapy
__________:
- access: dialysis catheter surgically places in abdomen
- types: CAPD and CCPD
peritoneal
