Acute and Chronic Renal failure, Kidney changes

Question 1

Causes of Acute Renal Failure

Answer 1

• Prerenal- (60-70%) of cases
  
  • Volume problem
  • hypovolemia, shock, blood loss, embolism, pooling of fluid(acities or burns) CHF and Cardio issues, sepsis
• Intrarenal- acute tubular necrosis(ATN)
  
  • Nephrotic agents(inc. Meds), Infections, ischemia/blockages, polycystic(large cysts Kill neph)
• postrenal- Obstruction
  
  • Stones, clots, BPH, Urethral Edema from invasive procedures

Question 2

Persons at risk for Acute renal failure include

Answer 2

Major surger

Major trauma

Recieving Nephrotoxic Meds

Elderly

those with previous kidney fucntion loss

Question 3

Phases of Acute Renal failure

Answer 3

DON’t Confuse Causes

• initiation occurs with insult
• oliguria with urinary output less than 40 ml/24 hours
• Rising K, BUN, Creatinine, not responsive to fluid challange
• Diurresis Period- Gradual increas in urinary output beginging recovery as renal functions improve
• Recovery may take 3-12 months, may have lasting permanant damage.

Question 4

Lab Profiles for Acute Renal Failure

Answer 4

Elevated BUN

Elevated Sodium, but H₂O retention may mask

Postasium Increased

Phosphours increased

Caclium DEcreased

Hemaglobin/Hematacrit DEcreased

Sp. Gravity DEcreased until fixing(urine wont concentrate)

Question 5

Management of Acute Renal Faliure

Answer 5

• Fluid Challanges and diuretics are used to enhance renal blood flow if the cause is prerenal
• Low doses of dopamine, if CHF
• Calcium channel blockers may be used to prevent influx of calcium into the kidney cells to maintain cell integrity and increase GFR

Question 6

Mangement of Acute Renal Failure related to HyperKalemeia

Answer 6

• HyperKalemia- closely monitor electrolytes
• Kayexalate/Sorbitol removes K+ through bowel
• 10 % IV Dextrose and Insulin and insulin and Calcium Gluconate may help Shift K+
• Na Bicarb used to shift K+ into the cell by correcting acidosis(this is an IV push
• Admin of Nephrotoxic meds done cautiously
• Monitor ABG’s and Acid-Base balance
• Montior phospate levels( binders may be needed)
• Temporay dialysis

Question 7

Chronic Renal Failure (CRF, CFD)

Answer 7

Progressive irreversible Deterioration of renal function

Question 8

Causes of CRF

S/S?

Answer 8

Diabetes, hypertension, glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, vascular disorders.

S/S similar to the ARF

Question 9

Uremia is ?

What are the S/S

Answer 9

Collection of Nitrogenous wastes normally excreted by the kidneys.

S/S include:

Head ache, Seziures, coma, dry skin, rapid pulse, hypertension, labored breathing

Question 10

Kidney Changes Include

Answer 10

• Nephrons Hyertrophy working harder until 70-80% of renal function is lost
• Nephrons compensate by decrasing water reabsorbtion leading to
  
  • Polyuria-increased urine output
  • Then a gradual decline in urine output

Question 11

Clinical Manifestations of kidney Changes

Answer 11

• Every body system is affected
  
  • CV Hypertension, heart failure, pulmonary edema pericarditis, MI
  • Pulm- Crackles, Kussmaul Resp, Pleuritic pain
  • Derm- Severe Pruritus(itching), Uremic Frost(Urea crystals)
  • GI- n/v, anorexia, uremic fector(ammonia Breath), constipation, or diareeha
  • Nero- LOC Changes, confusion, seizures, agitation, neuropathies

Question 12

Nurtritional therapy of kidneys

Answer 12

Azotemia and uremia are directly related to protein intake

Proteins must be High biological value/Complete protiens

ie Dairy, Eggs, meats