Chronic Renal Failure Complications

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Questions and Answers

Which complication of chronic renal failure is characterized by decreased platelet count and increased turnover leading to bleeding disorders?

Metabolic Acidosis

Platelet Abnormalities (correct)

Renal Bone Disease

Hyperkalemia

What is a key reason for patients preferring peritoneal dialysis over hemodialysis?

Higher risk of infection

Requires less dietary restriction (correct)

More complex vascular access needed

Increased frequency of treatment required

Which of the following endocrine abnormalities is most likely to occur in males with chronic renal failure?

Increased testosterone and decreased LH

Decreased production of thyroid hormones

Decreased testosterone and increased estrogen (correct)

Increased insulin clearance and hypoglycemia

During hemodialysis, what is the primary purpose of using heparin?

To prevent blood clotting Signup and view all the answers

In continuous ambulatory peritoneal dialysis (CAPD), what is a defining characteristic?

Involves repeating exchanges every 24 hours Signup and view all the answers

What is a potential serious complication of long-term hemodialysis?

Atherosclerosis and cardiovascular disease Signup and view all the answers

Which of the following is NOT a typical sign found in urinalysis?

Presence of glucose Signup and view all the answers

What complication might a patient undergoing peritoneal dialysis experience due to long-term use?

Abdominal hernias Signup and view all the answers

What can a low specific gravity in urine indicate?

Well-hydrated status Signup and view all the answers

Which of the following best describes the typical pH range of urine?

4.5 to 8.0 Signup and view all the answers

Which factor most directly influences the rate of air flow during respiration?

Air pressure variances Signup and view all the answers

How does an increase in lung compliance typically affect gas exchange?

Improves gas exchange efficiency Signup and view all the answers

What is the primary effect of metabolic acidosis on respiratory function?

Compensatory increase in CO2 excretion Signup and view all the answers

Which condition is associated with decreased compliance in the lungs?

Fibrosis Signup and view all the answers

Which laboratory finding is consistent with uncompensated metabolic acidosis?

Normal PCO2 levels Signup and view all the answers

What physiological event occurs when air flows through increasingly resistant airways?

Decreased airflow rate Signup and view all the answers

What happens to the urine pH in compensated metabolic acidosis?

It becomes acidic Signup and view all the answers

Which statement describes the impact of emphysema on lung compliance?

It increases compliance due to loss of elasticity Signup and view all the answers

What is the primary manifestation that distinguishes acute spasmodic laryngitis (ASL) from other croup syndromes?

Symptoms typically evident during the nighttime Signup and view all the answers

Which symptom is characteristic of acute epiglottitis in a child?

Tripod position with chin protruding Signup and view all the answers

Which of the following treatment options is most appropriate for acute spasmodic laryngitis (ASL) to relieve symptoms?

Warm steam of hot running water Signup and view all the answers

In assessing a child with suspected acute epiglottitis, why should the throat not be examined with a tongue blade?

It can trigger airway obstruction. Signup and view all the answers

What respiratory symptom commonly interferes with feeding in small infants during acute respiratory infections?

Obstruction from swollen nasal passages Signup and view all the answers

Which of the following is NOT a cause of respiratory acidosis?

Chronic hyperventilation Signup and view all the answers

What is a common symptom of respiratory acidosis?

Flushed skin Signup and view all the answers

Which age group is most commonly affected by acute laryngotracheobronchitis?

3 months to 8 years Signup and view all the answers

Which treatment is generally preferred for acute laryngotracheobronchitis?

Cool humidified air Signup and view all the answers

What distinguishes acute tracheitis from acute laryngotracheobronchitis?

Acute tracheitis often has high fever and thick, purulent exudate. Signup and view all the answers

Which bacteria is most commonly responsible for acute tracheitis?

Staphylococcus aureus Signup and view all the answers

What condition can lead to acute respiratory acidosis and respiratory failure in children?

Acute laryngotracheobronchitis Signup and view all the answers

Which treatment is critical for managing acute tracheitis?

Tracheostomy if necessary Signup and view all the answers

What is a characteristic cough associated with acute laryngotracheobronchitis?

Barking cough Signup and view all the answers

What is the normal range for Blood Urea Nitrogen (BUN) in adults?

8 to 21 mg/dL Signup and view all the answers

How is the BUN/Creatinine ratio affected with hypovolemia?

Increases above 10:1 Signup and view all the answers

What is considered a normal creatinine clearance for children?

70 to 140 mL/min/1.73 m2 Signup and view all the answers

Which factor does NOT cause an increase in serum creatinine levels?

Increased physical activity Signup and view all the answers

What is the normal range for uric acid excretion in healthy females over 24 hours?

250 to 750 mg/24 hr Signup and view all the answers

At what age does the normal serum creatinine level for males reach up to 1.2 mg/dL?

To adulthood Signup and view all the answers

What is the primary cause of bronchitis in children under the age of 4?

Viral infection Signup and view all the answers

Which symptom is characteristic of viral bronchitis?

Cough that worsens at night Signup and view all the answers

In chronic bronchitis, what changes occur in the airway mucus-secreting glands?

Increased number of mucus-secreting glands Signup and view all the answers

What treatment is typically NOT indicated for viral bronchitis?

Antibiotics Signup and view all the answers

During acute respiratory infections in children, what age group is most likely to experience the highest fever?

Children aged 6 months to 3 years Signup and view all the answers

In chronic bronchitis, what role do alveolar macrophages play?

They help clear infections. Signup and view all the answers

Which of the following is an important treatment option for acute episodes of chronic bronchitis?

Systemic corticosteroids Signup and view all the answers

What is a common misconception about the treatment of cough in viral bronchitis?

Cough suppressants should be used sparingly at night. Signup and view all the answers

What condition is often implicated in cases of chronic bronchitis in children?

Cystic fibrosis Signup and view all the answers

Which of the following best describes the cough associated with chronic bronchitis?

A persistent cough with increasing sputum production Signup and view all the answers

Study Notes

Complications of Chronic Renal Failure

Platelet Abnormalities: Characterized by decreased platelet count and increased turnover, leading to bleeding disorders.
Metabolic Acidosis: Impaired tubular cell function results in an accumulation of acids (phosphate, sulfuric, hippuric) causing congestive heart failure and muscle weakness.
Hyperkalemia: Inadequate potassium excretion due to dysfunctional nephrons; can be aggravated by potassium-sparing diuretics.
Renal Bone Disease: Decreased calcium, increased phosphate and parathyroid hormone disrupt vitamin D utilization, causing demineralization and possible metastatic calcification.
Multiple Endocrine Disorders: Altered hormone production leading to reproductive issues, insulin clearance problems, and associated metabolic dysregulation.
Cardiovascular Disorders: Includes left ventricular hypertrophy, fluid retention, and dysrhythmias, along with risks of pericarditis and congestive heart failure.
Anorexia and Malnutrition: Poor appetite and nausea contribute to hypoalbuminemia, exacerbated by restrictive diets.

Renal Dialysis

Indication: Primarily for patients progressing to end-stage renal disease (ESRD) or acute conditions.
Peritoneal Dialysis: Involves placing a catheter in the peritoneum to instill and drain sterile dialysate. It's preferred by those seeking independence and fewer dietary restrictions.
Continuous Ambulatory/Continuous Cyclic Peritoneal Dialysis: Features continuous exchanges or longer retention times with nightly drainage.

Hemodialysis

Frequency: Typically performed 3 times weekly for 3-4 hours; alternative short daily sessions are available.
Considerations: May interfere with daily activities, requiring strict dietary and fluid restrictions. Vascular access is needed, and heparin is used for anticoagulation.
Process: Blood is circulated through a dialyzer, a synthetic membrane that filters waste.

Complications Associated with Dialysis

Hemodialysis Complications: Risk of atherosclerosis, anemia, fatigue, hypotension, muscle cramps, and potential for dialysis disequilibrium.
Peritoneal Dialysis Complications: Mostly minor but can include peritonitis, leakage of dialysate, bleeding, and abdominal hernias.

Urinalysis Components

Color and Appearance: Normal is pale yellow to amber; may appear cloudy due to infections.
Odor: Slight odor; changes in odor may indicate infection or consumption of certain foods.
Specific Gravity and pH: Ranges from 1.015 to 1.025 and usually between 4.5 to 8, average at 5-6.
Sediment Analysis: Identifies casts (red, broad, white) associated with various renal conditions.
Negative Markers: Glucose, ketones, protein, blood, bilirubin, and nitrates should be negative; abnormal findings indicate pathology.

Renal Function Studies

Specific Gravity and Osmolality: Measures kidney concentration ability; normal values are 1.015-1.025 for gravity and 275-295 mOsm/kg for serum osmolality.
Uric Acid Levels: Varies by age and sex, increases with renal failure.
Creatinine Levels in Serum and Urine: Normal ranges differ by age and sex; elevations indicate renal impairment.

Respiratory System Fundamentals

Gas Exchange: Oxygen is transported to cells and exchanged for carbon dioxide; influenced by pressure, airflow, and lung compliance.
Compliance Factors: Decreased with conditions like pneumothorax, ARDS, and increased with diseases like emphysema.

Acidosis Types

Metabolic Acidosis: Causes include increased fixed acids or loss of base; diagnosed with decreased pH and altered bicarbonate levels.
Respiratory Acidosis Causes: Includes COPD, sedative overdose, obesity, and severe pneumonia; characterized by hypoventilation and associated symptoms like headache and drowsiness.

Pediatric Respiratory Conditions

Acute Laryngotracheobronchitis: Viral infection causing swelling of the airway; managed with humidified air and steroids.
Acute Tracheitis: Often bacterial; may lead to airway obstruction; treated with antibiotics and possibly intubation.
Bronchitis: Viral or bacterial inflammation with a productive cough; treated symptomatically, antibiotics not indicated for viral cases.

Chronic Bronchitis

Definition: Lasting cough and sputum for at least 2 consecutive years; associated with airway irritation and infections.
Symptoms and Treatment: Cough, dyspnea, frequent infections; managed with bronchodilators and corticosteroids as needed.

Pneumonia

Causes: Can be viral, bacterial, or due to chemical exposure; presents as inflammation filling alveoli with exudate.
Pneumonia Types: Lobar, bronchial/lobular, and interstitial, each defined by the location of inflammation.

Streptococcus pneumoniae

Role in Pneumonia: Most common bacterial cause; vaccine introduction significantly reduced incidence in vaccinated populations.
Mechanism: Induces inflammation leading to alveolar filling and consolidation.### Pneumonia Overview
Pleural effusions, super infections, bacteremia (15-25%), and pericarditis are potential complications.
Symptoms include abrupt onset with high fever (≥105°), chills, diaphoresis, cyanosis, chest pain, tachypnea, and tachycardia.
Altered consciousness and productive cough with rusty or green-tinged mucus may also present.

Treatment Options for Pneumonia

Common treatments include:
- Antipyretics for fever relief.
- Analgesics for pain management.
- Respiratory support as needed.
- Antibiotics: options include penicillins, ampicillin, 3rd generation cephalosporins, macrolides, erythromycin, tetracycline, and fluoroquinolones.

Haemophilus Influenzae

Colonizes upper respiratory tracts in children under 5, often leading to pneumonia.
Conjugated polysaccharide H. influenzae type b vaccine introduced in 1990 significantly reduced pneumonia cases.
Symptoms may emerge 2-6 weeks post upper respiratory infections; include fever, chills, and a productive cough.
Complications include bacteremia, lung abscesses, pleural effusions, epiglottitis, and pericarditis.

Viral Pneumonias

More common in adults; RSV particularly affects children under 5, potentially leading to pneumonia.
Viruses like adenoviruses, parainfluenza, cytomegalovirus, and coronaviruses can also cause pneumonia.
Symptoms include progressive cough, fever, dyspnea, cyanosis, and respiratory distress.
Treatments include rest, fluids, antipyretics, oxygen therapy, and ribavirin aerosol for severe RSV cases.

Mycoplasma Pneumoniae

Caused by pleomorphic microorganisms affecting cilia function and provoking an inflammatory response.
Primarily affects children and young adults aged 4-20; only about 3% develop pneumonia.
Occurs seasonally and in 4 to 8-year epidemic cycles.
Symptoms include paroxysmal cough, low-grade fever, myalgia, and diarrhea.

Hospital-Acquired Pneumonia (HAP)

HAP is significantly more lethal than community-acquired pneumonia (CAP), with death rates ranging from 20-40%.
Mortality can rise to 90% if patients are on mechanical ventilation.
Pseudomonas aeruginosa is a leading cause of HAP, associated with 40-60% mortality.
Transmitted through contaminated hands of healthcare staff or invasive devices, particularly risky for cystic fibrosis patients.
Symptoms include fever, cough, bradycardia, elevated WBC counts.

Aspiration Pneumonia

Results from aspiration of foreign objects or fluids, triggering an inflammatory response.
Common causes are fluid or food aspiration, with young children at high risk during feeding.
Symptoms mimic other pneumonia types: cough, dyspnea, respiratory distress, cyanosis.
Treatment involves removal of foreign objects, antibiotics, respiratory support, and preventive measures during feeding.

Bronchiolitis (RSV)

Bronchiolitis is characterized by bronchiolar inflammation primarily due to respiratory syncytial virus (RSV).
Also associated with adenoviruses, parainfluenza, and Mycoplasma pneumoniae.

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Description

This quiz covers the complications associated with chronic renal failure, including platelet abnormalities, metabolic acidosis, and hyperkalemia. Understand how these conditions affect overall health and the underlying mechanisms involved.