Acute and Chronic Kidney Disease Flashcards
What are the 3 types of acute kidney injury (AKA acute renal failure)?
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prerenal: affecting blood flow to the kidney
- CVA, hypovolemia, CHF, bradycardia
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intrarenal: inside kidney
- glomerulonephritis, polycystic kidney
-
postrenal: affecting flow out of the kidney
- kidney stones, strictures
What is prerenal azotemia?
any condition that reduces the blood flow to the kidneys, resulting in a build up of nitrogenous wastes
What are the 4 phases of AKI?
- onset – precipitating event
-
oliguric – reduced urine output = 100 - 400 mL/day
- administration of diuretics or fluid bolus has no effect
- elevated levels of BUN and Cr
-
diuretic – increased fluid output
- BUN and Cr levels return to normal
-
recovery – return to normal
- occurs approximately 12 months after onset of AKI
How does hypovolemic shock relate to AKI? What signs may indicate AKI?
– severe hypotension from shock can lead to decreased kidney perfusion and prerenal AKI
– signs:
- reduced output
- decreased weight
- labs that reflect poor kidney function – BUN, Cr, GFR
- nephrotoxic medications – be careful with dosing
What is chronic kidney disease (CKD)? What 3 things could CKD result in?
– chronic kidney disease (CKD): progressive, irreversible kidney injury – kidney function does not recover
– 3 possible results:
- end-stage kidney disease (ESKD) – kidney function not sustainable; dialysis needed
- azotemia – abdominal cramping, metallic taste in mouth from urea, fatigue
- uremia/uremic syndrome – damage to small BVs in kidneys
What are the 5 stages of CKD?
-
stage 1 – at risk
- reduced renal reserve
- GFR > 90 mL/min
-
stage II – mild CKD
- nephron damage
- slight elevation of metabolic waste
- GFR = 60 - 89 mL/min
-
stage III – moderate CKD
- continued nephron damage
- BUN, Cr increase
- restriction of fluids, electrolytes, protein
- GFR = 30 - 59 mL/min
-
stage IV – severe CKD
- manage complications
- prepare for renal replacement therapy
- GFR = 15 - 29 mL/min
-
stage V – ESKD
- severe fluid, electrolyte, acid-base imbalance
- fatal if no renal replacement therapy
- GFR < 15 mL/min
What are the main kidney changes that develop with CKD?
increase BUN and Cr, decreased urine output
What are the main metabolic changes that develop with CKD?
increased production of urea and creatinine (from muscle metabolism)
What are the main electrolyte changes that develop with CKD?
- decreased sodium in early stages; increased in later stages
- chronic increased potassium
- acid-base imbalance
- decreased calcium
- increased phosphorus
What are the main cardiac changes that develop with CKD?
- hypertension – contributes even further to renal failure
- hyperlipidemia
- HF
- pericarditis
What are the main hematologic changes that develop with CKD?
decreased EPO –> decreased RBCs
What are the main GI changes that develop with CKD?
uremia in mouth due to flora changes in mouth
What are dietary restrictions to consider for AKI pts?
- sodium – administer in early stages, restrict in later stages
- potassium – restrict intake
- bananas
- leafy greens
- fluid restrictions
What is a visible/physical manifestation of AKI?
uremic frost – tiny urea crystals form on skin after sweat evaporates
What is the purpose of hemodialysis, and who benefits from hemodialysis treatment? What should the nurse be wary of when pts are on hemodialysis?
– purpose – lower levels of GFR
– who – pts with AKI who don’t respond well to diuretics
– be wary of clot formations in the machine
- determine with an aPTT lab
- administer anticoagulants like heparin
When should subclavian dialysis catheters be used?
for short-term dialysis or when waiting for AV fistula to heal
What is an AV fistula?
graft or fusion of an artery and a vein together or long-term, permanent access to vascular system
What are complications of AV fistulas?
- thrombosis/stenosis
- infection
- aneurysm
- ischemia
- HF
How should medications be handled for pts on dialysis?
meds need to be flushed out during dialysis
What are the most common reactions in pts after dialysis?
- hypotension
- bleeding
- h/a
- n/v
- malaise
- dizziness
- muscle cramps
- avoid anything invasive 4 hours after dialysis
What are 2 complications of hemodialysis?
- dialysis disequilibrium syndrome
- sickness during/after
- fluid volume change
- electrolyte change
- infection
- hepatitis B
- hepatitis C
- HIV
What is peritoneal dialysis? What are the 3 types?
– peritoneal dialysis: catheter placed into abdominal cavity for infusion; used mostly for home environment
– 3 types:
- continuous ambulatory peritoneal dialysis
- automated intermittent
- continuous-cycle
What are some complications of peritoneal dialysis?
- peritonitis
- can prevent by making sure the connection site is sterile
- pain
- 1st time will be painful, but subsequent dialysis treatment shouldn’t be
- should be warmed on plate prior to prevent
- exit site/tunnel infections
- poor dialysis flow
- may need enema to prevent constipation
- dialysate leakage
Where is a transplanted kidney placed in the pt? What happens to the bad kidney?
– new kidney placed in iliac region of pelvis due to proximity to bladder and iliac vein
– bad kidney is not removed unless there is limited space in pt
What is important to assess post-operatively in pts receiving kidney transplants?
- assess hourly urine output x 48hr
- pink for a few days, then should return to yellow
- complications
- rejection
- tubular necrosis
- thrombosis
- renal artery stenosis
What medications should be held when pts are about to have hemodialysis?
anything vasoactive – like beta-blockers
Why is it expected for a pt coming off of dialysis to present with a higher temperature?
blood warms up in dialyzer
however, if temperature is low grade (101 F), worry about infection
