Acute and Chronic Renal failure Flashcards
what is acute renal failure
- inability for kidneys to excrete wastes, concentrate urine, and conserve electrolytes
3 causes of acute kidney failure
- prerenal (decrease kidney perfusion)
- intrinsic renal (damage to kidney structures: glomeruli, tubules, vasculature)
- postrenal (obstruction)
what are the prerenal causes of kidney failure
- dehydration (hypovolemia) from V/D
- DM
- surgical shock, trauma, burns
- accidental poisoning
- prolonged anesthesia
what are the intrinsic renal causes of kidney failure
- ingestion of nephrotoxic medications
- hemolytic uremic syndrome, acute glomerulonephritis
- ischemia
what are the postrenal causes of kidney failure
- kidney stones
- tumors
what are the principle features of acute renal failure
- oliguria, azotemia ( increased urea and creatinine) -> leading to metabolic acidosis, electrolyte disturbances
s/s of acute renal failure
- oliguria (<1mL/kg/hr)
- abrupt diuresis: sudden strong urge to urinate
- edema (pulmonary)
- circulatory collapse
- cardiac arrhythmia: hyperkalemia
- seizures: hyponatremia, hypocalcemia (tetany)
- tachypnea: metabolic acidosis
- CNS: from oliguria
lab/diagnostics for acute renal failure
- electrolyte imbalances
- kidney panel: decreased urine creatinine, GFR, increased BUN
- metabolic acidosis
- anemia: low Hgb, Hct
- azotemia, increased blood creatinine
- EKG
- IVP (intravenous pyelogram: xray and contrast) & MRI for kidney function
meds for acute kidney failure: hyperkalemia
- calcium gluconate
- sodium bicarbonate
- glucose and insulin IV
- sodium polystyrene sulfonate
meds for acute kidney failure: antihypertensives
- labetalol or sodium nitroprusside
- hydralazine, clonidine, or verapamil
- captopril, minoxidil, propranolol, nifedipine, furosemide
vasodilators, beta blockers, ace inhibitors, loop diuretic
treatment procedures for acute kidney failure
- dialysis (hemo or peritoneal)
- hemofiltration/ultrafiltration
when does acute kidney failure becomes chronic
- diseased kidneys can’t maintain body needs
- half of renal capacity destroyed
- irreversible damage to nephrons, leading to uremia (toxin build up)
potential causes of chronic kidney failure
- <5yrs: congenital, kidney & urinary tract malformations and vesicoureteral reflux
- 5+: VUR associated with recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis
pathophysiology of chronic kidney failure
- waste products accumulate
- water & Na retention and decreased urine excretion -> edema
- high K, P
- low Na, Ca (P & Ca inverse relationship)
- decreased hydrogen secretion & bicarb reabsorption -> metabolic acidosis
- decreased erythropoietin from kidney, shortened PRBC lifespan -> anemia
s/s of chronic kidney failure
- lethargy, fatigue
- pallor, bruising of skin
- delayed growth
- anorexia, N/V
- decreased urine output
- uremic odor from breath
- muscle cramps
- puffy face
- bone or joint pain
- amenorrhea
- circulatory overload: HTN, CHF, pulmonary edema
- neuro: tremors, twitching, confusion, seizures, coma
lab/diagnostics for chronic kidney failure
- eGFR: decreased maybe
- electrolytes: high K, P, low Na, Ca
- CBC: anemia
- blood creatinine & BUN: high
- ABG: metabolic acidosis
medications for chronic kidney disease
- nephrocaps: vitamins
- calcium carbonate: increase Ca, decrease PO4
- sodium bicarbonate: metabolic acidosis
- iron supplements, vit D, folic acid, erythropoietin: anemia
- growth hormone
- ace inhibitors “pril”
- lasix
diet education for chronic kidney disease
- adequate calories and proteins for growth
- restrict: Na, K, protein, water
- take: folic acid, iron
treatment for end stage chronic kidney disease
- dialysis
- transplant
- hemofiltration
what are acute s/s of transplant rejection
- fever
- malaise
- decreased urine output
- tachycardia, tachypnea
- weight gain
- poor appetite
what are the 3 types of dialysis that can be used for kidney failiure
- peritoneal dialysis
- hemodialysis
- hemofiltration (CRRT: continuous renal replacement therapy)
what type of dialysis is preferred for children? how does it work?
peritoneal dialysis: can be managed at home
- warmed solution enters peritoneal cavity and remains for period of time before removal
- abdominal cavity acts as semipermeable membrane for filtration
how does hemodialysis work
- requires vascular access
- best for children that can be in facility 3x a week for 4-6hrs
- achieves rapid correction of fluid & electrolytes
when is hemofiltration used (CRRT)
- continuous for pts that can’t tolerate large volumes of fluid removal
- done in ICUs only