10.4 Renal Failure

Question 1

Acute Kidney Injury (AKI)

Answer 1

• Results when kidneys are no longer able to regulate the volume or composition of urine appropriately.
• Typically due to some SUDDEN onset of illness/injury (such as acute glomerulonephritis or HUS)
• MAY BE REVERSIBLE (depending on how much damage has occurred)

S/S
- OLIGURIA (most primary symptom)
- Hypertension
- N/V
- Edema
- Electrolyte imbalances
- Metabolic Acidosis

Phases

• Oliguric Phase
  Point where they have severe decreased urinary output which puts body in fluid volume excess. This will cause increase in potassium because they cannot get excreted. They will also have hyponatremia (diluted sodium). Watch out for cardiac issues, muscle disturbances, seizures, heart failure.
• Diuretic Phase
  Rapid sudden increase in urinary output which may cause fluid volume deficit. This can cause a decrease in potassium

Treatment
- Control electrolytes (sodium/potassium)
- Fluid replacement during diuretic phase
- Albumin
- Dialysis

Question 2

Chronic Renal Failure

Answer 2

• IRREVERSIBLE (progressive damage) due to congenital anomalies or urinary reflux. Can also be caused by chronic glomerulonephritis.

S/S
- Similar symptoms to acute kidney injury
- Increased BUN and Creatinine
- N/V due to retention of toxins
- Hypertension/HF
- Oliguria
- Retention of Toxins

Treatment
- Dietary management
- Diuretics
- Erythopoietin
- Dialyis s

Question 3

Azotemia

Answer 3

• Accumulation of nitrogenous waste in the blood. NOT LIFE THREATENING. (Typically seen in AKI)

Question 4

Uremia

Answer 4

• A more advanced problem than Azotemia where retention of nitrogenous products produce toxic symptoms
• THIS IS SERIOUS AND CAN AFFECT OTHER BODY SYSTEMS

S/S
- Pruritis (due to increased uric acid in the body)
- Can also possibly smell urine in breath and skin due to major buildup

• TYPICALLY SEEN IN CHRONIC RENAL FAILURE

Question 5

Renal Failure Symptoms

Answer 5

• Oliguria
• N/V
• Lethargy
• Edema
• Hypertension
• Electrolyte Disturbances
• Pallor (due to low blood volume because kidneys create erythropoietin)
• WATCH OUT FOR HIGH POTASSIUM BECAUSE KIDNEYS ARE NOT FILTERING PROPERLY. WATCH OUT FOR CARDIAC SYMPTOMS OR MUSCLE SYMPTOMS

Antidote for High Potassium
- Kayexalate

Question 6

Nutrition/Hydration

Answer 6

• Fluid restriction to 0 balance (intake must be identical to output. We want kids to excrete what they are taking in because they can easily suffer from water intoxication and dilution of sodium)
• High carbohydrate and fat diet for energy
• Foods should be low in protein
• Sodium and water restriction IF THERE IS HYPERTENSION OR EDEMA PRESENT

Question 7

Dialysis

Answer 7

Hemodialysis
- Blood is extracted from patient and a machine filters the blood for you (acts as a glomerulus)
- These kids need to watch what they drink in between hemodialysis treatment
- Treatment is typically 3 times a week

Peritoneal Dialysis
- Peritoneal membrane is used as a filter
- Dialysate fluid is warmed and infused into the abdomen which extracts toxins then drained out into a bag.
- The drainage you get should be clear straw color. If it is cloudy it typically indicates infection
- This is used for those who cannot tolerate hemodialyisis

Question 8

Hemolytic Uremic Syndrome (HUS)

Answer 8

• Main cause of renal failure

Question 9

Epogen

Answer 9

• This is an erythropoietin given to children to target against anemia

Question 10

Metabolic Acidosis

Answer 10

• Most often seen in patients with renal failure