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Questions and Answers
Which dialysis method is particularly suitable for patients with cardiovascular disease?
Which dialysis method is particularly suitable for patients with cardiovascular disease?
What is the duration of intermittent peritoneal dialysis?
What is the duration of intermittent peritoneal dialysis?
What complication is most associated with peritoneal dialysis?
What complication is most associated with peritoneal dialysis?
What is the primary purpose of histocompatibility testing in renal transplantation?
What is the primary purpose of histocompatibility testing in renal transplantation?
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When does hyperacute rejection typically occur after renal transplantation?
When does hyperacute rejection typically occur after renal transplantation?
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What is a common postoperative manifestation of acute rejection?
What is a common postoperative manifestation of acute rejection?
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Which type of graft rejection occurs more than 60 days after transplantation?
Which type of graft rejection occurs more than 60 days after transplantation?
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What is one of the advantages of peritoneal dialysis?
What is one of the advantages of peritoneal dialysis?
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Which phosphate binder is commonly used in the treatment of hyperphosphatemia?
Which phosphate binder is commonly used in the treatment of hyperphosphatemia?
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What is the preferred vitamin D supplement for treating hypocalcemia in chronic kidney disease (CKD)?
What is the preferred vitamin D supplement for treating hypocalcemia in chronic kidney disease (CKD)?
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Which medication is administered to stimulate red cell production in patients with anemia related to CKD?
Which medication is administered to stimulate red cell production in patients with anemia related to CKD?
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What is one of the potential complications of hemodialysis?
What is one of the potential complications of hemodialysis?
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Which iron product is known for being better tolerated compared to iron dextran in hemodialysis patients?
Which iron product is known for being better tolerated compared to iron dextran in hemodialysis patients?
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Which treatment is typically used to manage gastrointestinal disturbances in CKD patients?
Which treatment is typically used to manage gastrointestinal disturbances in CKD patients?
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What is the primary reason for using heparin during the hemodialysis process?
What is the primary reason for using heparin during the hemodialysis process?
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For which condition is intravenous iron typically administered in CKD patients?
For which condition is intravenous iron typically administered in CKD patients?
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Which class of medications is primarily used to manage edema in patients with chronic kidney disease (CKD)?
Which class of medications is primarily used to manage edema in patients with chronic kidney disease (CKD)?
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What is the main dietary intervention recommended for slowing the progression of CKD?
What is the main dietary intervention recommended for slowing the progression of CKD?
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Which of the following imaging procedures may reveal small kidneys in CKD patients?
Which of the following imaging procedures may reveal small kidneys in CKD patients?
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What is a common treatment for hypertension particularly seen in patients with chronic kidney disease?
What is a common treatment for hypertension particularly seen in patients with chronic kidney disease?
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What is a key goal of nonpharmacologic therapy for managing chronic kidney disease?
What is a key goal of nonpharmacologic therapy for managing chronic kidney disease?
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Which diuretic is most commonly used in patients with chronic kidney disease?
Which diuretic is most commonly used in patients with chronic kidney disease?
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In diagnosing CKD, what might a urinalysis reveal?
In diagnosing CKD, what might a urinalysis reveal?
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What is the specific goal of managing systemic manifestations of CKD?
What is the specific goal of managing systemic manifestations of CKD?
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Study Notes
Chronic Kidney Disease (CKD)
- Characterized by reduced kidney function
- Serum calcium levels are decreased
- Serum potassium and phosphate levels are elevated
- Sodium levels may be reduced
- Anemia is present, normocytic, normochromic, with hematocrit ranging from 20% to 30%
- Urinalysis reveals:
- Glycosuria
- Proteinuria
- Erythrocytes
- Leukocytes
- Casts
- Specific gravity is fixed at 1.010
- Kidney size is typically reduced, measuring less than 8 cm in length
- Structural assessments of the kidney can be carried out using various imaging techniques:
- Ultrasonography
- Intravenous urography (IVU)
- Plain abdominal radiography
- Computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
Treatment Objectives
- Improve patient comfort and prolong life
- Treat systemic manifestations of CKD
- Correct body chemistry abnormalities
Nonpharmacologic Therapy
- A low-protein diet (0.6 to 0.75 g/kg/day) may slow the progression of CKD, especially in patients with or without diabetes
- Dietary measures and fluid restriction can alleviate symptoms of CKD and may increase patient comfort and extend life until dialysis or renal transplantation is required
Pharmacologic Treatment
Management of Edema
- Angiotensin-converting enzyme (ACE) inhibitors and diuretics are used to manage edema, congestive heart failure (CHF), and increase urine output
- ACE inhibitors include: captopril, enalapril, lisinopril, fosinopril
- Osmotic and loop diuretics are used
- Thiazide-like diuretics, with metolazone being the most common in CKD
Management of Hypertension
- Antihypertensive agents are frequently necessary in CKD due to edema and high renin levels.
- ACE inhibitors are a primary treatment option
- Calcium-channel blockers (e.g., amlodipine, felodipine) can be used as alternatives to ACE inhibitors
- β-Adrenergic blockers (e.g., propranolol, atenolol) are used to reduce blood pressure through various mechanisms
- Other antihypertensive agents, such as α-adrenergic drugs, clonidine, and vasodilators like hydralazine, may also be employed
Management of Hyperphosphatemia
- Phosphate binders, such as aluminum hydroxide or calcium carbonate, are administered to treat elevated phosphate levels
Management of Hypocalcemia
- Oral calcium salts and vitamin D are used to correct low calcium levels
- Calcitriol (active form of vitamin D) is the preferred vitamin D supplement due to its greater efficacy and shorter duration of action
- Other vitamin D preparations include dihydrotachysterol, ergocalciferol, doxercalciferol, and paricalcitol
Management of Other Systemic Manifestations of CKD
-
Anemia:
- Iron (e.g., ferrous sulfate), folate supplements, and epoetin alfa are used to treat anemia
- Severe anemia may require packed red blood cell transfusions
- Epoetin alfa stimulates red cell production and hemoglobin synthesis, accelerating reticulocyte release from the bone marrow
- Darbepoetin is an analog of epoetin alfa
- Intravenous iron products, such as iron dextran, sodium ferric gluconate, and iron sucrose, are used to replenish iron stores
-
Gastrointestinal Disturbances:
- Antiemetics help manage nausea and vomiting
-
Skin Problems:
- Antipruritic agents, like diphenhydramine, are used to alleviate itching
Dialysis
-
Hemodialysis is the preferred method for patients with a reduced peritoneal membrane, hypercatabolism, or acute hyperkalemia
- Involves shunting blood through a dialysis membrane for diffusion, osmosis, and ultrafiltration
- Blood is then returned to the patient's circulation
- Vascular access is achieved via an arteriovenous fistula or an external shunt
- Procedure lasts 3 to 8 hours, with most patients requiring three treatments per week
- Hemodialysis can be performed at home with proper training
- Heparin is administered during hemodialysis to prevent clotting
- Potential complications include:
- Clotting of the hemofilter
- Hemorrhage
- Hepatitis
- Anemia
- Septicemia
- Cardiovascular problems
- Air embolism
- Rapid shifts in fluid and electrolyte balance
- Itching
- Nausea, vomiting
- Headache
- Seizures
- Aluminum osteodystrophy
-
Peritoneal dialysis is preferred for patients with bleeding disorders or cardiovascular disease
- Uses the peritoneum as a semipermeable membrane
- A catheter inserted into the peritoneum provides access for the dialysate, which draws fluids, wastes, and electrolytes across the peritoneal membrane
- Peritoneal dialysis can be performed in three modes:
- Intermittent peritoneal dialysis: Automatic cycling mode lasting 8 to 10 hours, performed three times a week. Suitable for working patients.
- Continuous ambulatory peritoneal dialysis: Performed daily for 24 hours with four exchanges daily. Allows for patient activity during treatment.
- Continuous cyclic peritoneal dialysis: Used if other modes fail to improve creatinine clearance. Dialysis occurs at night, with the last exchange remaining in the peritoneal cavity during the day, drained in the evening.
- Advantages of peritoneal dialysis:
- Lack of serious complications
- Retention of normal fluid and electrolyte balance
- Simplicity
- Reduced cost
- Patient independence
- Reduced or no need for heparin administration
- Complications of peritoneal dialysis:
- Hyperglycemia
- Constipation
- Inflammation or infection at the catheter site
- High risk of peritonitis
Renal Transplantation
- Surgical procedure offering a chance for patients with end-stage renal disease to live normal and potentially longer lives
-
Histocompatibility testing is crucial to minimize rejection and failure:
- Human leukocyte antigen (HLA) type, mixed lymphocyte reactivity, and blood group types are assessed
- Renal transplant material can be obtained from living donors or cadavers
- Three types of graft rejection can occur:
-
Hyperacute (immediate) rejection: Occurs within minutes to hours after transplantation
- Intraoperative signs include: acute urine flow cessation, bluish or mottled kidney discoloration
- Postoperative manifestations include: kidney enlargement, fever, anuria, local pain, sodium retention, hypertension
- Treatment involves immediate nephrectomy
- Acute rejection: Can occur 4 to 60 days after transplantation
- Chronic rejection: Occurs more than 60 days after transplantation
-
Hyperacute (immediate) rejection: Occurs within minutes to hours after transplantation
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Description
This quiz covers essential aspects of Chronic Kidney Disease (CKD), including its characteristics, diagnostic criteria, and treatment objectives. Explore the clinical features, laboratory findings, and imaging techniques relevant to CKD management. Enhance your understanding of nonpharmacologic therapies and patient care strategies.
