Urinary2- Renal Dz Part 3

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  1. Signs of CKD are usually only present in IRIS stage(s) _______.
  2. 3 steps to managing CKD.
    • 1. treat underlying cause
    • 2. slow progression
    • 3. treat signs and symptoms
  3. What are the traditional features of kidney friendly diets? (3)
    reduced protein, reduced phosphorous, omega-3 enriched
  4. Is it worth it to feed CKD patients kidney friendly diets?
    yes- dogs lived 3 times longer, majority of cats outlived the study
  5. What is the most common appetite stimulant used in treating CKD?
  6. What are a few ways to get a CKD patient to eat a new renal diet? (2)
    don't change food in hospital (bad association), warm the food
  7. 2 primary hormones that control calcium and phosphorous metabolism.
    PTH, calcitriol  (calcitonin plays a minor role)
  8. PTH increases ________ ad decreases ________.
    calcium; phosphorous
  9. Calcitriol function.
    increase calcium
  10. PTH __________ calcitriol; calcitriol _________ PTH.
    increases; decreases
  11. How does calcitriol work?
    increases active absorption of calcium in the GI
  12. Phosphorous is filtered at the __________ and reabsorbed in the ___________ by _____________.
    glomerulus; proximal tubule; co-transport with Na+
  13. Hyperphosphatemia with CKD greatly increases ____________.
    risk of death
  14. In early CKD, there is ________ fractional excretion of phosphate and ________ calcitriol, leading to...
    increased; decreased; plasma phosphorous conc maintained in normal limits
  15. In late CKD, there is ________ plasma phosphrous, ________ calcitriol, __________ ionized calcium, _________ PTH; the kidney is unable to __________ fractional excretion of phosphate; this leads to... (3)
    increased; decreased; decreased; increased; increase; decreased survival time, soft tissue mineralization, and demineralization of bone.
  16. Mineralization of soft tissue occurs with _________, but not with _________.
    CKD; AKI
  17. What are the goals of therapy for CKD in Stages II-IV?
    • Stage II: Ph<5.0
    • Stage III: Ph<5.5
    • Stage IV: Ph<6.0
  18. What do you control phosphate in CKD patients? (2)
    restrict dietary intake, prevent absorption from GI with Ph binders (aluminum or calcium compounds)
  19. Formulas to predict iCal based on ______________ are not accurate for CKD patients.
    total Ca2+ and albumin
  20. Hypercalcemia occurs with _______________.
    renal tertiary hyperparathyroidism
  21. Uniquely, horses with CKD may have __________ because they absorb a lot of it from their gut.
  22. What is renal tertiary hyperparathyroidism?
    parathyroid gland increases PTH production to try and overcome hypocalcemia and hyperphosphatemia associated with CKD--> hypercalcemia
  23. How can you treat renal tertiary hyperparathyroidism? In what species is this effective?
    give calcitriol; dogs, but you must control phosphorous first
  24. What are GI signs of CKD? (3 common, 2 less common)
    common: nausea, vomiting, anorexia; less common: hematemesis, melena
  25. The ____________ elicits the vomiting reflex; __(2)__ are drugs that block receptors here.
    chemoreceptor trigger zone; cerenia, zofran
  26. To secrete gastric acid, you need __(3)__; therefore, types of drugs you can use for CKD patients with GI signs include...
    Ach, Histamine, gastrin; histamine receptor blockers or proton pump blockers
  27. What drug do you use to treat gastric ulceration in a CKD patient?
  28. With CKD, you should typically reduce Na+ _______ and _______.
    slowly and moderately
  29. Most CKD patients are polyuric, causing K+ __________, which leads to __________.
    wasting; muscle weakness
  30. AKI is associated with ______-kalemia; CKD is associated with ______-kalemia.
    hyper; hypo
  31. Cervical ventroflexion is associated with __________.
    hypokalemia due to CKD
  32. Why shouldn't you put KCl into SQ fluids?
    it stings, give it in IV fluids
  33. Don't exceed _________ K+ replacement because it can cause __________.
    0.5mEq/kg/hr; arrhythmias and death
  34. Uniquely, CKD cattle usually have a ___________ acid-base status because...
    metabolic alkalosis; alkaline diet and kidneys are responsible for excreting bicarb.
  35. _______ patients are often anemic; ________ patients usually are not.
    CKD; AKI
  36. Why is there commonly anemia in CKD patients? (3)
    erythropoietin is synthesized in the kidneys- necessary for RBC production in BM, increase RBC loss with GI perf, decreased RBC survival due to uremia
  37. What are side effects of erythropoietin stimulating agents? (6)
    hypertension, seizures, EPO resistance, iron deficiency, vomiting, polycythemia
  38. Blood pressure equation.
    BP= stroke volume x HR x total peripheral resistance
  39. What is the most important endocrine influence on BP?
  40. Nervous system control on BP.
  41. What organs are at most risk with hypertension? (4)
    eye, heart, kidney, brain
  42. How does hypertension affect the heart?
    left ventricular hypertrophy
  43. Ocular changes associated with hypertension.
    retinal detatchment
  44. Neurological effect of hypertension.
  45. Types of drugs that are antihypertensive. (4)
    ACE inhibitors, AngII receptors inhibitors, Ca2+ channel blockers, beta/alpha blockers
  46. CKD dogs with BP _________ are 3 times more likely to die.
    >160bpm (hypertension)
  47. How do ACE inhibitors benefit CKD patients? (2)
    antihypertensive, decrease proteinuria
  48. In CKD patients, platelet count is _________, but...
    normal; platelet function is abnormal.
Card Set:
Urinary2- Renal Dz Part 3
2015-10-04 00:56:16
vetmed urinary

vetmed urinary
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