Chronic Renal Failure - College of Pharmacy-Handout2012

Stages of crf stage 5 end stage renal disease esrd

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Stages of CRF Stage 5 End-stage renal disease (ESRD), Kidney failure (GFR <15 ml/min/1.73m 2 ) Severely symptomatic Malaise, fatigue, pruritis, nausea, vomiting, leg cramps, myoclonus, asterixis, seizures, clouded sensorium, minimal urine output Require renal replacement therapy (RRT- dialysis or transplantation) for survival
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Patient Case #1 AK is a 26 WF who presents with a 3 month complaint of “no energy and being tired all the time”. She also notes that she rarely goes to the bathroom anymore and when she does it is only a small amount. She also complains that she does not have the appetite she once had. Initial BP at home was 155/105 and repeat in the clinic is 165/110.
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Patient Case #1 What stage of CKD does AK have? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 E. Stage 5 Stage 3-4
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Patient Case #1 What are her symptoms? AK is a 26 WF who presents with a 3 month complaint of “ no energy and being tired all the time”. She also notes that she rarely goes to the bathroom anymore and when she does it is only a small amount . She also complains that she does not have the appetite she once had. Initial BP at home was 155/105 and repeat in the clinic is 165/110.
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Epidemiology CRF affects 10-15% of the US Estimated 6% growth rate per year Significant morbidity and mortality CRF increases mortality associated with primary diseases Advances in medical care have stabilized the death rate
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Etiology Diabetes (34%) Initially presents as proteinuria due to thickening of glomerular basement membrane and increased glomerular pore size Hypertension (23%) Volume dependent, responds to RRT Increase in renin increase of angiotensin II Sympathetic hyperactivity due to reduced baroreceptor activity
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Etiology Glomerulonephritis (16%) Inflammatory disease of the kidney Drug-induced CRF NSAIDS ACE-inhibitors/ARB’s Aminoglycosides IV contrast Antibiotics
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Etiology Others causes Urinary tract infections Polycystic kidney disease Systemic lupus erythematosus Obstruction Tubular disease Cancers HIV, Viral Hepatitis
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Risk Factors Advanced age Reduced kidney mass and low birth weigh Racial/ethnic minority Family history Low income or education Systemic inflammation Dyslipidemia
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Risk Factors Diabetes Hypertension Autoimmune disease Kidney diseases/Urinary complications Drug toxicity Smoking Modifiable or Not!
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Pathophysiology Loss of nephron mass, glomerular capillary HTN, proteinuria High pressure affects permeability of membrane and increased albumin excretion Proteinuria causes direct cellular damage Proteins also upregulate inflammatory cytokines
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Patient Case #1 PMH: uneventful FH: Father – HTN x 20 years, Mother – Lupus x 20 years, 1 older brother and sister alive and well SH: - smoking, - drugs, + alcohol (2-3 drinks on weekends, + caffeine (2-3 cups a day) Meds: Multivitamin daily, Motrin as needed for pain (training for a marathon past few months)
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Patient Case #1 What are AK’s risk factors for CKD?
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