End stage renal disease (ESRD) (Smarty PANCE) Questions and
Answers Rated A
What is the definition of end stage renal disease Diuretics
(ESRD)?- When the residual renal function Control BP
is no longer sufficient to excrete the daily load of EPO and vit D supplements
toxins, and metabolic waste products accumulate
so that symptoms of uremia begin to occur. At What is hemodialysis?- A process in which
this stage, renal replacement therapy (dialysis or blood flows on 1 side of a semipermeable
transplantation) is required to sustain life membrane with dialysate on the other side. Small
molecules (electrolytes, urea, creatinine, but not
At what GFR does ESRD generally occur?- proteins) pass freely through this membrane,
GFR is usually <10-15 mL/min diffuse down a concentration gradient, and are
removed from the body. At the same time,
What are the most common causes of ESRD in substances such as HCO3− are added to the
the United States?- DM 40% blood from the dialysate.
HTN 5%
GN 10% What is ultrafiltration?- The process of
Interstitial nephritis 5% removing volume from the patient via hydrostatic
Cystic or hereditary diseases 3% pressure applied by the machine across the
membrane. Some solutes are removed with
In patients with CKD, when should dialysis be ultrafiltration, by the mechanism of "solvent drag"
initiated?- Metabolic disarray persists or convection. Typically, patients undergo both
despite the use of restrictions and supplements, dialysis (to remove toxins) and ultrafiltration (to
worsening acidosis, volume overload, nausea, remove excess volume).
pericardial friction rub, neuropathy, decreased
mental status, worsening nutritional status, and What are the complications associated with
debilitating fatigue. There is no evidence hemodialysis?- Hypotension, nausea,
showing clear benefit of initiating hemodialysis changes in mental status, infection, blood loss,
when patients are asymptomatic as opposed to muscle cramps, and cardiac arrhythmias. Most
uremic. complications are related to the rapid shifts in
fluid, electrolytes, and osmolality that occur with
At what GFR does this usually occur?- dialysis.
Generally, dialysis is initiated when GFR <
10-15 mL/min. What are the different forms of hemodialysis
access?- 1. Dual-lumen catheter: Placed in
What are some examples of renal replacement a large central vein (such as the internal jugular).
therapy?- Haemodialysis Usually tunneled underneath the skin
Peritoneal dialysis 2. Arteriovenous fistula: A surgically constructed
Transplantation connection between an artery and a vein in the
arm
What are some ways of managing CKD?- 3. Arteriovenous graft: A surgically implanted
Gore-Tex tube that connects an artery and a vein
Control systems hypertension
RAAS blockade
Avoid high protein intake What is Kt/V?- A clearance term that
salt reduction reflects the removal of urea during dialysis. It
avoid nephrotoxins allows monitoring of therapy and identification of
1/2
Answers Rated A
What is the definition of end stage renal disease Diuretics
(ESRD)?- When the residual renal function Control BP
is no longer sufficient to excrete the daily load of EPO and vit D supplements
toxins, and metabolic waste products accumulate
so that symptoms of uremia begin to occur. At What is hemodialysis?- A process in which
this stage, renal replacement therapy (dialysis or blood flows on 1 side of a semipermeable
transplantation) is required to sustain life membrane with dialysate on the other side. Small
molecules (electrolytes, urea, creatinine, but not
At what GFR does ESRD generally occur?- proteins) pass freely through this membrane,
GFR is usually <10-15 mL/min diffuse down a concentration gradient, and are
removed from the body. At the same time,
What are the most common causes of ESRD in substances such as HCO3− are added to the
the United States?- DM 40% blood from the dialysate.
HTN 5%
GN 10% What is ultrafiltration?- The process of
Interstitial nephritis 5% removing volume from the patient via hydrostatic
Cystic or hereditary diseases 3% pressure applied by the machine across the
membrane. Some solutes are removed with
In patients with CKD, when should dialysis be ultrafiltration, by the mechanism of "solvent drag"
initiated?- Metabolic disarray persists or convection. Typically, patients undergo both
despite the use of restrictions and supplements, dialysis (to remove toxins) and ultrafiltration (to
worsening acidosis, volume overload, nausea, remove excess volume).
pericardial friction rub, neuropathy, decreased
mental status, worsening nutritional status, and What are the complications associated with
debilitating fatigue. There is no evidence hemodialysis?- Hypotension, nausea,
showing clear benefit of initiating hemodialysis changes in mental status, infection, blood loss,
when patients are asymptomatic as opposed to muscle cramps, and cardiac arrhythmias. Most
uremic. complications are related to the rapid shifts in
fluid, electrolytes, and osmolality that occur with
At what GFR does this usually occur?- dialysis.
Generally, dialysis is initiated when GFR <
10-15 mL/min. What are the different forms of hemodialysis
access?- 1. Dual-lumen catheter: Placed in
What are some examples of renal replacement a large central vein (such as the internal jugular).
therapy?- Haemodialysis Usually tunneled underneath the skin
Peritoneal dialysis 2. Arteriovenous fistula: A surgically constructed
Transplantation connection between an artery and a vein in the
arm
What are some ways of managing CKD?- 3. Arteriovenous graft: A surgically implanted
Gore-Tex tube that connects an artery and a vein
Control systems hypertension
RAAS blockade
Avoid high protein intake What is Kt/V?- A clearance term that
salt reduction reflects the removal of urea during dialysis. It
avoid nephrotoxins allows monitoring of therapy and identification of
1/2
