Acute & Chronic Kidney Failure (Disease) Primer Flashcards
Renal failure results in the inability of the body to…
• Excrete metabolic waste
Compare the onset of acute vs chronic kidney failure.
- Acute: Sudden onset
* Chronic: Insidious onset over many years
Compare the most common causes of acute vs chronic kidney failure.
- Acute: acute tubular necrosis
* Chronic: Diabetic nephropathy
What is acute tubular necrosis?
• A kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure
What are some causes of acute tubular necrosis?
• Heart attacks, strokes, and clots that cut off blood flow to your kidneys
What is diabetic nephropathy?
- a common complication of type 1 and type 2 diabetes.
- Over time, poorly controlled diabetes can cause damage to blood vessel glomeruli of the kidneys.
- This will impair filtration, cause high blood pressure, and other issues, ultimately leading to kidney failure.
Compare dx criteria of acute vs chronic kidney failure.
- Acute: Urine OP reduction, rise in serum creatinine, progressive elevation of BUN levels
- Chronic: GFR < 60mL/min for 3 months
Compare reversibility of damage in acute vs chronic kidney failure.
- Acute: damage reversible if caught early, though it has a high mortality rate
- Chronic: irreversible and progressive
Compare primary cause of death in acute vs chronic kidney failure.
- Acute: Infection
* Chronic: Cardiovascular disease
Acute Kidney Injury (AKI): Explain pre-renal etiology.
- Source of damage is to circulation BEFORE the blood hits the kidney.
- This causes a reduction in glomerular perfusion and overall filtration of kidneys
- This reduction in glomerulus pressure causes autoregulatory mechanisms to be triggered
What are some examples of pre-renal conditions that can cause AKI?
- Dehydration
- Burns
- Any condition that lowers BP
Why do pre-renal conditions trigger the autoregulatory mechanisms?
- The body perceives low glomerular pressure as low body fluids
- The autoregulatory mechanisms are triggered to try and reverse this by retaining fluids to raise pressure back up and restore glomerular/renal function
What autoregulatory mechanisms are triggered by a decreased glomerular pressure?
• ↑ ADH, ↑ Renin, ↑ Aldosterone → Na and H2O retention and ↓ urine OP
Acute Kidney Injury (AKI): Explain intrarenal etiology.
• Direct damage to the parenchyma (functional tissue) impairs nephron functioning
What are some conditions that cause intrarenal AKI?
- Prolonged renal ischemia
- Nephrotoxins (aminoglycosides)
- ↑ Hgb from hemolyzed RBCs
- ↑ Myoglobin from necrotic muscle cells
- Acute tubular necrosis
Acute Kidney Injury (AKI): Explain post-renal etiology.
• This occurs when there is a mechanical obstruction that can cause reflux
What are some causes of post-renal AKI?
- BPH
- Prostate cancer
- Calculi (stones)
- Trauma
- Extra renal tumors
True or False
Urine OP is useful in determining etiology of renal failure
• True
Anuria may indicate what condition?
• UTI obstruction
Oliguria may indicate what etiology of AKI?
• Pre-renal
What specific gravity value indicates renal failure?
• 1.007-1.010
What is the normal WBC range in urine?
• 0-5
Elevated WBCs in urine indicates…
• Infection
What is the normal RBC range in urine?
• 0-4
Is it normal to have WBCs or RBCs in urine?
• Trace amounts can be ok, otherwise there should be none
True or False
Urine osmolality is used to measure the number of dissolved particles per unit of water in the urine. As a measure of urine concentration, it is more accurate than specific gravity.
• True
What is urine osmolality?
- an index of the concentration of osmotically active particles, particularly chloride, sodium, urea, and potassium
- glucose can also add significantly to the osmolality when it is abundant in urine.
True or False
In a healthy state, the specific gravity of the urine corresponds to the urine osmolality
• True
A urine osmolality of 300 is indicative of…
• Osmotic diuresis
What is osmotic diuresis?
• When the body is unable to reabsorb water and sodium
What are some s/s of acute AKI?
- (OX SOUP FACT)
- Oliguria or anuria (decreased or absent urine OP)
- Xerostomia (dry mouth), thirst
- Swelling
- Orthostatic BP
- Uremic frost
- Pale skin
- Fatigue
- Asterixis (low calcium)
- Confusion
- Tachycardia
What is the nursing management for AKI?
- Strict I/Os
- Vitals
- Fluids
- Urinary assessment
- Treat underlying infection (fluids/abx)
- Rest
- Daily weight
- Observe skin and manage edema
What are the two main causes of chronic kidney disease?
- Diabetes Mellitus
* Hypertension
True or False
CKD is frequently asymptomatic until 80% of nephrons are damaged
• True
What is normal GFR of a healthy kidney?
• 125mL/min
A GFR of < 15mL/min indicates…
• The pt will need dialysis
GFR of < 10mL/Min will result in…
• Uremia
What is uremia?
• a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys.
What are the urinary s/s of CKD?
- Uremia
- Polyuria
- Fluid retention
- Anuria
What causes CKD metabolic disturbances?
• Waste product accumulation in the blood as a result of kidney dysfunction
How does a decreased GFR affect BUN and Creatinine levels?
• Both will be elevated
What are the s/s of ↑ BUN?
- N/V
- Lethargy, impaired thought
- Fatigue
True or False
BUN levels are more accurate indicators of kidney function than Serum creatinine and creatinine clearance tests.
• False, Serum creatinine and creatinine clearance tests are more accurate
CKD impairs carbohydrate metabolism. How does this affect glucose and insulin?
- Cells become insensitive to insulin, thus cellular glucose uptake will be reduced.
- This reduction results in glucose and insulin circulating in the blood (hyperglycemia and hyperinsulinemia)
Why do diabetic CKD pts that become uremic require less insulin?
• Kidney excretion is impaired causing it to stay in the system longer
What are triglycerides?
- A type of fat (lipid) found in your blood.
* When you eat, your body converts any calories it doesn’t need to use right away into triglycerides.
What is dyslipidemia?
• Elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein cholesterol level that contributes to the development of atherosclerosis
Explain how hyperinsulinemia leads to cardiovascular disease.
- High levels of insulin in the blood triggers the hepatic production of triglycerides that leads to dyslipidemia
- Without correction, dyslipidemia will cause atherosclerosis and cardiovascular disease.
- Cardiovascular disease is the leading cause of death for pts w/ CKD
Calcium and phosphate have what kind of relationship?
• Inverse, if one goes up, the other goes down
Normal serum calcium range?
• 8.5-10.2
Normal serum phosphorus range?
• 3-4.5
Normal serum magnesium range?
• 1.3-2.1
Normal serum potassium range?
• 3.5-5.5
How does CKD cause anemia?
- ↓ renal production of erythropoietin results in ↓ bone marrow RBC production
- ↑ parathyroid hormone also inhibits erythropoiesis, shortening life of RBC and causes bone marrow fibrosis
CKD patients need to take what supplements to assist erythropoiesis?
• Iron and folic acid
True or False
There is a greater bleeding tendency for CKD pts due to defects in platelet function.
• True
CKD may manifest what cardiovascular complications?
- Heart failure
- Left ventricular hypertrophy
- Peripheral edema
- Dysrhythmias
- Uremic pericarditis
What are some respiratory manifestations of CKD?
- Dyspnea, Kussmaul’s respirations (Deep, rapid breathing)
- Pulmonary edema
- Uremic pleuritis
- Pleural effusion (build-up of excess fluid between the layers of the pleura outside the lungs)
- Predisposition to respiratory infections
What are some GI system clinical manifestations of CKD?
- Stomatitis (swollen oral mucosa)
- Uremic fetor (piss breath)
- GI bleeding
- Anorexia, N/V
What aspects of CKD cause neurological issues?
- ↑ Nitrogenous waste products
- Electrolyte imbalances
- Metabolic acidosis
What specific damage does CKD cause to neurological tissues?
- Axonal atrophy
* Demyelination of nerve fibers
What are the neurological s/s of CKD?
- Depression
- Lethargy/apathy/fatigue
- Irritability/lack of concentration
- Seizure/twitching/asterixis
- Parathesias
- Peripheral neuropathy
What is peripheral neuropathy?
• conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased.
What is the diagnostic testing done for CKD?
- GFR
- Renal ultrasound
- Renal biopsy
- CT scan
- 24hr urine collection
What are the parameters around proteinuria to keep in mind?
• Persistent proteinuria (positive ≥2 times in a 3 month period) will need further assessment
Why may a CKD pt develop hyperkalemia?
- When insulin effect wears off, K+ leaves the cells and serum levels rise
- As glucose/insulin management is more precarious w/ the CKD pt, we need to keep a close eye on s/s of hyperkalemia
How is hyperkalemia treated w/ CKD pts?
- Keep pt on a potassium restricted diet.
- Admin sodium bicarbonate (to reduce K+ levels)
- Admin Kayexalate (to reduce K+ levels)
How does kayexalate get rid of potassium?
- Increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract.
- Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, resulting in a reduction of serum potassium levels.
Hyperphosphatemia is associated with what cardiac condition (other than HTN)?
• cardiac hypertrophy, which may worsen cardiac contractility and heart failure.
How may Hyperphosphatemia be treated to lower HTN?
• w/ calcium-based phosphate binders that will bind w/ phosphate in the bowels and be excreted
When are calcium-based phosphate binders administered?
• w/ meals
If iron and folic acid supplements aren’t working to stimulate erythropoiesis, how else may CKD induced anemia be treated?
• Via exogenous erythropoietin (IV or SubQ)
Why should iron supplements NOT be taken at the same TIME as phosphate binders?
• Calcium binds w/ iron and will prevent absorption
What are our LDL and Trigliceride level goals when treating the CKD pt?
- LDLs <100
* Triglycerides <200
CKD patients should have a diet low in ____, _____ and _____.
- Sodium
- Potassium
- Phosphate
What are some examples of dietary sodium to be avoided?
- Salt
- DASH diet items
- Cured meats, hot dogs, cold cuts
- Pickled foods
- Canned food
- Soy sauce and salad dressings
What are some examples of dietary potassium to be avoided?
• Oranges, bananas, melons, tomatoes, prunes, raisins, deep green and yellow vegetables, beans, and legumes
What are some examples of dietary phosphate to be avoided?
• Dairy products
