PMED - CKD & Dialysis

Kidney Disease

→ can be caused by acute infection, obstruction in the urinary tract, or chronic conditions.

1. they regulate fluid volume,

2. filter waste and toxins,

3. maintain acid - base balance of plasma

4. synthesize and release hormones

5. serve as the target organ for parathormone and aldosterone

the kidneys have several important functions:

Nephron

→ functional unit of kidney

125 mL/ min/1.73 m2

the precursor of urine, is produced in nephrons at a rate of about ______

Chronic Kidney Disease

• abnormalities of kidney structure or function, present for 3 months or longer, with implications for health

→ diabetes

→ hypertension

primary etiologies of CKD

→ Diabetes Mellitus
→ Hypertension
→ Chronic Glomerulonephritis
→ Polycystic Kidney Disease

FOUR common causes of ESRD

STAGE 1

the national kidney foundation defines a five stage classification system for CKD;
what stage is:
→ characterized by normal or only slightly increased GFR associated with some degree of kidney damage.

→ This stage usually is asymptomatic, with a slight (10%–20%) decline in renal function

STAGE 2

what stage is:
→ is marked by a mildly decreased GFR.

STAGE 3

what stage is:

→ is evidenced as a moderately decreased GFR (30–59 mL/min), with loss of 50% or more of normal renal function. 

STAGE 4

what stage is:
→ is defined by a severely decreased GFR (15–29 mL/min).

STAGE 5

What stage is:
→ reflected by renal failure, wherein 75% or more of the approximately 2 million nephrons have lost function (GFR <15 mL/min)

UREMIA

The resultant clinical syndrome—caused by renal failure, retention of excretory products, and interference with endocrine and metabolic functions

180 L/day

The kidneys filter approximately ________ through about 2 million nephrons.

deterioration and destruction of functioning nephrons

The main pathologic process in renal failure is the ____ and ____ of functioning nephrons

• Glomerulus

• Tubules

• Vasculature

parts of nephron

UREMIA

patient with advanced renal disease develop ______, which uniformly fatal if not treated.

HYPERKALEMIA

→ higher than normal levels of potassium

AZOTEMIA

• buildup of nonprotein nitrogen compound in the blood, mainly urea, as a consequence of loss of glomerular filtration function

Blood Urea Nitrogen (BUN)

level of azotemia is measured as _______

• Anemia

• Leukocyte dysfunction

• Platelet dysfunction

• Coagulopathy

Hematologic abnormalities in patients with End - Stage Renal Disease

Platelet Factor 3

Enhances the conversion of prothrombin → thrombin by activated factor X

Renal Osteodystrophy

Bone disorders associated with ESRD are collectively called

Osteomalacia

Increased unmineralized osteoid bone matrix

UREMIC FROST

Whitish coating on the skin caused by residual urea crystals after sweat evaporates.

• Stomatitis

• Oral ulceration

• Oral Candidiasis

• Parotitis

• Smell and taste disturbances

• Urine-like odor of the breath (uremic odor)

Oral Manifestation of CKD

GFR

The ______ is the best measure of overall kidney function,

albumin (albuminuria)

he most significant protein in the urine is ______

Serum creatinine level

a measure of muscle breakdown

and filtration capacity of the nephron

DIALYSIS

a medical procedure that artificially filters the blood