Chronic Renal Failure - College of Pharmacy-Handout2012

Nutrition reduced oral intake uremia dietary

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Nutrition Reduced oral intake Uremia Dietary restrictions Loss of protein and water soluble vitamins during dialysis Dialysis induced catabolism
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CNS/Neuromuscular Urea irritates brain and peripheral nerves Peripheral neuropathy Atrophy and demyelination of nerve fibers Lower extremities > upper Neuromuscular irritability Leg cramps, fatigue, restless leg syndrome Uremic encephalopathy Alertness/awareness, loss of memory, lethargy, asterixis, coma and seizures
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Anemia Hgb < 10 g/dL, Hct < 30% Kidneys produce 90% of erythropoetin Uremia blunts RBC production in bone marrow Normochromic, normocytic anemia Fatigue, lethargy, SOB, angina, insomnia Iron deficiency Nutritional restrictions Blood loss during dialysis
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Anemia 2200 Blood viscosity Heart rate Peripheral vasodilation which leads to vascular resistance Cardiac output increases to maintain perfusion which leads to ventricular hypertrophy Limits myocardial oxygenation angina Along with HTN contributes to LVD and CHF
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Uremic Bleeding Platelet production is normal but function is impaired Bleeding is further complicated by menorrhagia, GI bleeding and bruising of skin structures Anemia may accentuate position of platelets along endothelial surface Dialysis improves but does not resolve coagulopathy
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Immune Function Immune function is altered by urea and metabolic waste 2200 Granulocytes, impaired humoral and cell-mediated immunity Hypogammaglobulinemia 2200 IgG levels increase infection risk Treatments for CRF suppress the immune system May require alterations in immunizations Dialysis access has high rates of infection
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Dermatology Pruritis caused by phosphate levels and phosphate/calcium deposition Dry skin due to sweat and oil glands Pale skin due to anemia Skin integrity diminished due to repeated needle sticks with infection risk Urea crystals or “frost” forms on skin Fingernails become thin and brittle
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Endocrine Insulin resistance Hyperlipidemia Dysmenorrhea Metabolic syndrome or “Syndrome X”
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Sexual Dysfunction Multifactorial: uremic toxins, neuropathy, endocrine function, psychological factors and medications Impotence is common and may be caused by testosterone and prolactin and luteinizing hormone 2200 Libido from anemia and testosterone 2200 With time on dialysis and disease progression
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Sexual Dysfunction 2200 Sexual drive in women due to alterations is prolactin, progesterone and luteinizing hormone Infertility, menstrual irregularities and amenorrhea are common Following transplantation recovery of sexual dysfunction and manifestations is common
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Patient Case #1 ROS: Mild edema in lower extremities, noted recent weight gain of 10 lbs, along with dry, pale skin.
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