In CKD the disease progresses as the functioning 'pool' of nephrons declines. This leads to afferent arteriole dilation and efferent contraction. Progressive glomerular flow and pressure subsequently causes glomerular HTN and endothelial damage, which is expressed as glomerular sclerosis. Thus central effort to protect remaining functional glomeruli are?
Increased afferent vasodilation
Increased afferent vasoconstriction
Increased efferent vasodilation
Increased efferent vasoconstriction
Increasing systemic pressures
Reducing systemic pressures
The medications that help in slowing progression of CKD are?
-EPO is important as it is produced in the kidney and production falls as falls.
-Iron as Fe2+ intake is lowered in CKD and losses occur (blood tests, bleeding, ). Iron demand is also increased by EPO Rx.
-Folate, Vitamin B & Vitamin C.
-Phosphate binders- PO4 retention occurs with reducing GFR. Most hemodilaysis removes poory. Calcium binders () are an effective way of forming inabsorbable Ca3(PO4)2 for fecal excretion.
-Vitamin D is converted from inactive to active in the kidney. Vitamin D () promotes increased Ca2+ uptake which suppresses PTH and therefore reduces bone loss.
-ACE/ ARB's important for controlling systemic and flow.
Other important medications in CKD are:
-Anti- agents: As a result of long-standing HTN, concentric LVH results which renders subendocardial ischaemic. Aggressive treatment of HTN and angina may: decrease angina, reduce LVH, reduce symptomatic LV Failure.
-Lipid Lower Agents: Hyperlipidaemia can be severe in , and accelerate atherosclerosis. Treatment is with .
-PPI's- help reduce GI ulceration, symptoms and aggravated .
-Na+/Bicarbonate as accompanies CKD, however risks include which may aggrevate HTN and LVF.
Indications for Renal Replacement Therapy include: hyperkalemia, fluid overload, uremia, acidosis, impaired creatinine clearance <10 and failure to correct with conservative methods.
The principles of hemodialysis are:
Blood flows on one side of a semi-permeable membrane
The pores of the semi-permeable membrane allow water and small MW solutes to pass through
The pores of the semi-permeable membrane allow water and high MW solutes to pass through
The net rate cannot be manipulated by dialysate make-up
The net rate can be manipulated by dialysate make-up
Advantages of hemodialysis include:
Advantages of PD include:
-Freer diet and fluid allowances