1Role of PT
Assess and evaluate
Prescribe exercise
help with pain management, balance, and mobility
help with identifying or preventing secondary sarcopenia and osteopenia and other issues that arise with chronic illness
2What would make you suspect a renal issue?
global, unexplained edema
intense, unexplained back pain
unstable vitals and hemodynamic response
3Blood Tests
Creatinine
BUN: Blood, Urea, Nitrogen
GFR: Glomerular Filtration Rate
Electrolytes
4Urine Tests
Leukocytes
Protein
pH
Blood
Ketones
Microalbuminuria
5Creatinine Clearance Test
over time how kidneys function
blood and urine
9elevated CK levels means what
something is dying/dead
10concerning CK
above 2.0, can riske with age as muscle tissue breaks down
11Creatine vs Creatinine
Creatine is formed during protein metabolism, involved in energy supply for muscles #gymrat
Creatinine is a waste product, formed during metabolism of creatine
12BUN helps to determine what
kidney or liver damage
13reference range for BUN
7-25 mg/dL
14Neurological Disturbances caused by uremia
altered cognitive function (encephalopathy) - extra ammonia around
imapired taste (dysgeusia)
loss of apetite (anorexia)
15other symptoms of uremia
nausea and vomiting
bleeding (dysfunctional platelets)
grey discoloration of the skin
16normal values of GFR _______ with age
decrease
17What can we do to help raise GFR?
moving them around because vasoconstriction helps push blood flow through the kidneys
18Large change in GFR but little change in creatinine indicates
early renal disease
19large change in creatinine but little change in GFR indicates
advanced renal failure
20electrolytes are important because
basis of maintaining homeostasis
21Na+ Sodium
regulation of __________ and ________ fluids
transmission of _______ __________
_____ activity
certain _______ functions
blood and body
nerve impulses
heart
metabolic
22K+ Potassium
____ function
muscle ______
_____ abnormalities
________ balance
neuron
cramping
EKG
osmotic (increase in edema, increase seepage)
23Cl- Chloride
________ metabolism
______ ______ balance
______ neurotransmission
transport of _______
gastric
acid base
CNS
proteins
24HCO3- Bicarbonate
buffer the ____ of the body
pH
25What are we looking for in a urinalysis?
RBC, WBC, Nitrites, Hemoglobin
26Color of Urinalysis, typical and abnormal
Typical - yellow
Abnormal - varied due to illness, drugs, or diet
27Clarity or transparency of urine
Typical: clear
Abnormal - due to insoluble elements
29Dark red urine
blood and protein from excess tissue death
31in rhabdomyolysis CK MM is
high af because lots of muscle death
32_____% of rhabdo patients in acute renal failure, ____% mortality rate
7-10, 8
33Types of Rhabdo
Physical, Mechanical, Chemical
34Cause of physical Rhabdo
exertion - local to exerted muscles
fever, hyperthermia - global muscle breakdown
35causes of mechanical rhabdo
crush injury, compression, compartment syndrome
36compartment syndrome
painful and dangerous
pressure build up from internal bleeding and swelling of tissues
37causes of chemical rhabdo
medications
excessive alcohol use
endocrine disorders
infections
electrolyte abnormalities
38local rhabdo clinical features
swelling, pain, muscle weakness
39systemic rhabdo clinical features
fever, fatigue, hypotension, arrythmias
electrolyte balance is off because kidneys are overloaded by CK
40why does rhabdo cause decreased urine output?
proteins and big molecules need more dilution, so can get backed up and take time
41treatment for rhabdo
physical rest and corection of electrolyte imbalance #hydration
1st hydration and rest
2 if not better in 24 hours then IV hydration and rest
3 IV bicarbonate (bc of acidosis from CK increase) and IV hydration and rest
4 hemodyalysis and IV bicarbonate and rest
42State the renin angiotensin system in order
1. Drop in BP, or fluid volume
2. Renin releases from Kidney
3. Renin acts of angiotensinogen to form angiotensin I
4. ACE release from lungs
5. ACE acts on angiotensin I to form angiotensin II
6a. Angiotensin II acts on the adrenal gland to stimulate release of aldosterone
7a. aldosterone acts on the kidneys to stimulate reabsorption of salt and water
6b. Angiotensin II also acts directly on blood vessels, stimulating vasoconstriction
Negative feedback loop!
43Erythropoietin cycle step by step
1. Low oxygen tension at proximal tubule
2. Epo stimulates stem cells in bone marrow
3. RBCs produced, - feedback on EPO
4. Increases oxygen carrying capacity
44people with pulm/cardiac disease have _____ levels of RBCs and hemoglobin
high levels
45Hemodialysis access points
Artery to vein
in the forearm (AV Graft), can also do a central line
AV fistula - connect the artery and vein for easier dialysis access
46for peritoneal dialysis, how does the dialysate bag work?
the fluid has special iions that draw out bad stuff
47peritoneal dialysis has a risk of
infection at the catheter site
48Hemodialysis: time and place, access, assistance, complications, and prescription frequency
3-4 hrs per session or 3x per week in center treatment 85%
Central line or AV graft or fistula
Medical professional (Dialysis RN)
Fluid shifts affect HR and BP, fatigue, Access site infection
90%
49Peritoneal Dialysis: time and place, access, assistance, complications, and prescription frequency
30-40 min 4x per day or cycled overnight, at home
Peritoneal catheter
Can be done by trained family member
infection, catheter malfunction, dehydration, hyperglycemia, hernia, peritonitis
10%
50Adults with CKD have
Lower _______
what symptoms?
reduced _____ performance and ______ _______
VO2 max
anemia, fatigue, ms wasting, reduced work capacity
cardiac, muscle mass
51Adults on Dialysis have
decreased _________ ___________
more than 2SD _____ age/ gender norms and often ____ (exercise capacity)
functional capacity
below, lower
52Regular exercise can
Improve -
Fatigue severity improves with _________ exercise during dialysis but exercise must _______ to maintain the effect
physical functioning, exercise tolerance, and HRQOL
low-level, continue
53________ intensity exercise can improve __________ _________ and improve _____
what dosage?
low-mod, exercise capacity, BP
3x per week at 40-70% of target HR on stationary bike
54Aquatic therapy at ____ intensity for what dosage?
improvement in what 3 things?
low, 30 min 2x per week for 12 weeks
cardiorespiratory function, resting BP, and enhanced GFR
55Exercise on both dialysis and non HD days showed greater improvements in ________ ___________ and ______ ______ ______
exercise tolerance
peak VO2 max
56Gentle stretching and warm up followed by ______ intensities of _________% of THR followed by _____ intensity cool down and relaxation can increase ________ ________
aerobic, 50-60, low, exercise tolerance
57Medical management of acute kidney failure
electrolye repletion, fluids, dialysis to remove toxins
58medical management of chronic kidney disease
anti-hypertensives, drugs to lower cholesterol, diuretics, trat anemia, low protein diet, drugs to preserve bone health, eventual progression to dialysis
59NSAIDs _______ renal blood flow
reduce
GFR is not maintained
60why is there an increased risk of ADE with kidney dysfunction?
when kidney function declines, increased risk of leaving drugs to accumulate in the blood
some drugs require kidney to metabolize them into inactive forms
61How does renal dosing help with pharm?
adjust the dose based on kidney function
62ACE inhibitors or Angiotensin II Receptor Blockers (ARBs) are medicines that
help protect the kidneys