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Nursing - Bloomberg > 💊370: Renal > Flashcards

💊370: Renal Flashcards

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1
Q

What is Uremia?

A

Renal function declines to 10% of normal

Uremic toxins accumulate

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2
Q

What is Acute Kidney Injury (AKI)?

A

Abrupt loss of renal function
⬆️SCr ⬆️BUN >10-15% baseline

Can progress to CKD

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3
Q

What are life threatening complications of AKI?

A
  1. Hyperkalemia
  2. Pulmonary edema
  3. Heart failure
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4
Q

What are supportive management measures for AKI?

A
  1. Correct intravascular volume status with pRBCs, plasma expanders, or diuretics
  2. Treat precipitating condition
  3. Withdraw nephrotoxic drugs
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5
Q

What is the cause of Hyperkalemia?

A

Kidney unable to excrete K+
➡️ redistributed our of cells during metabolic acidosis

Drugs (ACEIs)

Can cause arrhythmia and cardiac arrest

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6
Q

What lab values indicate hyperkalemia?

A

Severe: >= 7.0 mmol/L

K+ = 6.0-6.9 with ECG changes

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7
Q

What are the interventions for hyperkalemia?

A
  1. Reduce risk of arrhythmias
    ➡️ IV Calcium
  2. Shift K+ into cells
    ➡️ Insulin (+glucose)
    ➡️ Sodium bicarbonate
    ➡️ Inhaled salbutamol
  3. Remove K+
    ➡️Cationic exchange resins
    ➡️ Dialysis
    ➡️ Diuresis
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8
Q

What are erythropoiesis stimulating agents (ESA) used for?

A

Anemia of CKD

Structurally identical to endogenous EPO

Release reticulocytes from bone marrow

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9
Q

What is a prototype of erythropoiesis stimulating agents (ESA)?

A

Epoetin alfa (Eprex)

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10
Q

What are side effects of erythropoiesis stimulating agents (ESA)?

A
  1. Hypertension
  2. Risk of CV events
  3. Pure red-cell aplasia (PRCA)
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11
Q

What are non-pharmacological therapies for Hyperphosphatemia?

A
  1. Dietary restrictions (no dairy, beans, beer, meats)
  2. Dialysis
  3. Subtotal or Total parathyroidectomy
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12
Q

What are examples of Phosphate binders?

A
  1. Calcium

2. Sevelamer (Renagel)

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13
Q

What are pharmacological treatments of Hypocalcemia and Hyperparathyroidism?

A
  1. Vitamin D ⬆️ Ca absorption and suppresses PTH synthesis
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14
Q

What are common nephrotoxic drugs?

A
  1. NSAIDs
  2. Aminoglycosides
  3. Vancomycin
  4. Sulfonamides
  5. Amphotericin B
  6. Cyclosporine
  7. Radio-contrast media
  8. Cisplatin
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15
Q

What are the 3 major functions of the nephron?

A
  1. Filtration
  2. Reabsorption
  3. Secretion
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16
Q

What is the function of the Glomerulus/Bowman’s Capsule?

A

Filtration
Allows passage of small molecules (H2O, NaCl, glucose, amino acids, urea)

Stops cells, platelets, and proteins

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17
Q

What is the major functions of the Proximal Tubule?

A

Reabsorbs:

  1. NaCl
  2. Glucose
  3. K+
  4. H2O/water
  5. Protein
  6. Urea
  7. Amino acids
  8. HCO3
  9. PO4

Secretes:

  1. H+
  2. Foreign substances
  3. Anions + cations
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18
Q

What is the major functions of the Loop of Henle?

A

Concentration of urine

Descending:

  1. Water reabsorption
  2. NaCl diffuses in

Ascending:

  1. Na+ reabsorption
  2. Water stays in

Urea secretion in thin segment

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19
Q

What are the major functions of the Distal Tubule?

A

Reabsorbs:

  1. NaCl
  2. Water (ADH required)
  3. HCO3

Secretes:

  1. K+
  2. Urea
  3. H+
  4. NH3+
  5. Some drugs
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20
Q

What are the functions of the Collecting Duct?

A

Reabsorbs:
1. Water (ADH required)

Absorbs/secretes:

  1. Na+
  2. K+
  3. H+
  4. NH3+

Urea secretes in medulla

21
Q

What are signs associated with kidney disease or injury?

A
  1. Albuminuria
  2. Hematuria
  3. Reduced GFR
  4. Low blood protein
  5. Edema
22
Q

What is the average urinary output in healthy patients?

A

180 L/day

GFR > 90mL/min

23
Q

What are the forces that influence glomerular filtration rate (GFR)?

A
  1. Glomerular blood hydrostatic pressure
  2. Plasma colloid osmotic pressure
  3. Capsular hydrostatic pressure
24
Q

What is the most common cause of AKI?

A

Dehydration (hypovolemia) leading to poor perdición to kidneys

25
Q

What is Acute Tubular Necrosis (ATN)?

A

Damage to tubules from toxins or ischemia

26
Q

What is Glomerulonephritis?

A

Inflammation of the glomeruli caused by immune response

27
Q

What is the pathophysiology of Glomerulonephritis?

A
  1. Antigen-antibody complexes produced in response to infection become trapped in glomerulus
  2. Causes inflammatory damage, reducing capacity for selective permeability
  3. Allow larger molecules to enter filter ➡️ proteinuria + hematuria
28
Q

What are signs of Glomerulonephritis?

A
  1. Hematuria
  2. Proteinuria
  3. Hypertension
  4. Edema (hypoalbuminemia ➡️ third spacing)
29
Q

What is the pathophysiology of Pyelonephritis?

A
  1. Fibrosis and scar tissue formation of kidney pelvis and parenchyma after infection
  2. Interferes with tubular absorption and secretions

Recurrent infections increase scar tissue

30
Q

What are signs and symptoms of Pyelonephritis?

A
  1. Fever
  2. Abdominal pain
  3. Dysuria
  4. Cloudy urine
  5. Polyuria or urgency
  6. Urinary odour
31
Q

What is Nephrotic Syndrome?

A

Manifestation of kidney failure

Caused by group of diseases that damage kidneys filtering system

32
Q

What are signs and symptoms of Nephrotic Syndrome?

A
  1. Proteinuria >3g protein/ day
  2. Edema
  3. Foamy urine
  4. Weight gain
  5. Hypoalbunemia
  6. Hematuria
33
Q

What is Nephritic Syndrome?

A

Nephron inflammation

Acute onset

34
Q

Azotemia

A

Nephrotoxicity that involves excess nitrogen compounds (urea, creatinine, etc)

⬆️ BUN + SCr
Crystallized urea deposits

Can occur in all types of AKI

35
Q

What is the normal pH of urine?

A

4.8-8.0

Diabetes and starvation ⬇️pH
Infections ⬆️pH

36
Q

What is the normal range of urinary Specific gravity?

A

1.025-1.032

⬆️dehydration, UTI, glucosuria, renal artery stenosis, decreased perfusion

⬇️ renal failure, pyelonephritis, Acute tubular necrosis, excess fluid

37
Q

Casts in urinary microscopic analysis

A

Precipitate from cells lining the renal tubules

38
Q

Crystals in urinary microscopic analysis

A
  1. Infection
  2. Inflammation
  3. Stones
39
Q

Epithelial cells in urinary microscopic analysis

A

Degeneration, necrosis of tubule cells

40
Q

What is the normal range for BUN?

A

3.6-7.1 mmol/L

10-20mg/dL

41
Q

What is the normal range of serum creatinine?

A

Women: 45-90
Men: 60-110 micromol/L

42
Q

What is the best estimation of functioning renal tissue?

A

GFR

43
Q

Creatinine is primarily excreted by the GF after being constantly released by which tissue?

A

Muscle

44
Q

What conditions result in prerenal injury?

A
  1. Renal Artery vasoconstriction
  2. Renal Artery thrombosis
  3. Hemorrhage
  4. Hypotension
45
Q

What hormone is synthesized and secreted by the kidneys?

A

Erythropoietin to produce RBC in bone marrow

46
Q

What are causes of infra-renal AKI?

A
  1. Acute Tubular Necrosis

2. Glomerular, tubular or interstitial damage

47
Q

What are causes of postrenal AKI?

A
  1. Renal calculi
  2. Ureteral stricture
  3. Benign prostatic hyperplasia (BPH)
  4. Tumor
  5. Blood clots in ureters/urethra
48
Q

What are causes of prerenal AKI?

A
  1. Hypovolemia
  2. Decreased cardiac output
  3. Thrombo-embolitic obstruction of renal vasculature
49
Q

What are signs of Azotemia?

A
  1. ⬆️ BUN + SCr
  2. Uremic frost

Can occur in all types of AKI

Nursing - Bloomberg (52 decks)

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