NP35 Nephrology

Chronic Kidney Disease/End Stage Renal Disease

Essential Med Notes 2015

Prevention of Progression
as above
control of HTN, DM, cardiovascular risk factors (e.g. smoking cessation)
avoid nephrotoxins
address reversible causes of AKI

End Stage Renal Disease

end stage renal disease represents a decline in kidney function which can occur over days to
weeks (AKI), over months to years (CKD), or as a combination of the two

Presentation of End Stage Renal Disease

1. Volume Overload
due to increase in total body Na+ content
signs: weight gain, HTN, pulmonary or peripheral edema
2. Electrolyte Abnormalities
high
K+ (decreased renal excretion, increased tissue breakdown)
PO43- (decreased renal excretion, increased tissue breakdown)
Ca2+ (rare; happens during recovery phase after rhabdomyolysis-induced AKI or in
settings where hypercalcemia contributes to renal failure, such as in multiple myeloma or
sarcoidosis)
uric acid
low
Na+ (failure to excrete excessive water intake)
Ca2+ (decreased Vit D activation, hyperphosphatemia, hypoalbuminemia)
HCO3 (especially with sepsis or severe heart failure)
3. Uremic Syndrome
manifestations result from retention of urea and other metabolites as well as hormone deficiencies

CNS: headache, lethargy, somnolence,

confusion, asterixis, hyporeflexia

PNS:
wrist drop

GI: decreased taste

RESPIRATORY: shortness of
breath, pleuritic chest pain

PNS:
foot drop

CVS: pericardial
friction rub
ENDOCRINE: weight loss,
amenorrhea,
decreased libido
GI: anorexia,
nausea, vomiting

GU: irritative and/or

obstructive urinary tact
symptoms, hematuria,
palpable bladder

MSK: nocturnal muscle

cramps, muscle weakness

Figure 19. Signs and symptoms of end stage renal disease

PNS:
glove and
stocking
neuropathy

Alice Zheng 2014

SKIN: pruritus, pallor,

yellow discoloration