Acute Kidney Failure and Chronic Kidney Disease Flashcards
what is acute renal failure (ARF)?
an abrupt decease in renal function sufficient enough to result in retention of nitrogenous waste and disrupt fluid and electrolyte homeostasis
what are the diagnostic criteria for ARF?
- increase in serum creatinine levels
- decreased urine output
- presence of oliguria or anuria
- lab results
- hyperkalemia
- acidaemia
- hypocalcemia
- hyperphosphataemia
- clinical findings
- fluid overload
- altered mental status
- nausea
- anorexia
- pericarditis
what types of damage can drugs and toxins do to the kidneys?
- decrease renal perfusion
- direct tubular injury
- intratubular obstruction
- immunological-inflammation
list some drug classes associated with decreased renal perfusion
- NSAIDs
- ACEi
- contrast media
- amphotericin B
- cyclosporine
- tacrolimus
list some drugs that cause direct tubular injury
- Aminoglycosides
- contrast media
- amphotericin B
- methotrexate (used to treat RA)
define chronic kidney disease (CKD)
a condition characterized by a gradual loss of kidney function over time
what is usually a sign of CKD?
persistent proteinuria
List some causes of CKD
- DM
- HTN
- Glomerulonephritis
- inherited disease, such as polycystic kidney disease
- anatomic anomalies
- Automimmune disease (SLE)
- Obstructions (kidney stones, tumors, enlarged prostate)
- repeated UTIs
what is relationship between GFR stages and kidney disease/function?
increasing number (G1 - G5) = decrease in kidney function (decreased GFR)
how many stages of kidney failure are there?
5 stages
describe stage 1 of kidney failure
- gradual onset of symptoms
- possibly reversible
- microalbumina
- elevated BUN and creatinine
describe stages 2-4 of kidney disease
- progressive kidney disease
- progressive increase in urine albumin levels
- Azotemia → accumulation of nitrogen containing waste products in blood
what is the clinical manifestation of Stage 5 kidney disease?
- end stage renal disease (ESRD)
- anemia
- CV
- increased presence of CV risk factors including diabetes, HTN, CAD, CHF
- volume overload
- GI
- N/V, anorexia, gastritis, malnutrition
- MS
- renal osteodystrophy-increased bone resorption
- myopathy (proximal muscle weakness)
describe stage 5 kidney disease
- loss or nearly complete loss of kidney function
- Uremia
- kidneys unable to excrete toxins, maintian pH, fluid or electrolyte balance
- requires transplant or dialysis
what is hemodialysis?
removal of blood from the body that is sent across a semipermable membrane and dialysate. The pressure gradient filter favors the removal of harmful substances
blood is then returned to the body
preformed 3-4x a week
what measurement can help us determine dialysis adequacy?
URR (urea reduction rate)
each treatment of dialysis should reduce urea level by at least 65%
what is peritoneal dialysis?
also called continuous ambulatory dialysis
a sterile solution is run through a tube into the peritoneal cavity
exchange occurs between this dialyzing solution and the vasculature of the peritoneal cavity
requires a permanent opening in the wall of the abdomen
T/F: peritoneal dialysis is more efficient than hemodialysis?
FALSE
less efficient, refilling abdominal cavity repeated 4-5x daily
can be performed at home and has fewer AE but greater risk of infection
what is the impact of dialysis on a patient’s diet?
the patient must keep the levels of electrolytes, minerals, and fluid in their body very balanced
fluid intake is limited
patient intake of salt, potassium, phosphorus, and other electrolytes are limited
at times difficult for pt to get enough calories
initially low protein diet then progress to high protein diet
T/F: a patient must limit fluid between dialysis treatments?
TRUE
very important
hyponatremia
can increase preload
list some AE of dialysis
- fluid shifts
- depression/oscillating mood status
- increased risk of infection
- immune suppressed
- openings in the skin
- malnutrition, anorexia, loss of lean body mass
- progressively increasing osmotic concentrations as time since dialysis lengthens
what is the most common cause of CKD?
Type I diabetes
what is the effect of DM on the kidneys?
- hyperglycemia leads to glomerular hyperfiltration which can damage the arterioles and capillaries of the glomerulus
- thickening of glomerular basement membrane
- intraglomerular HTN
what is the impact of HTN on the kidney
HTN → damages renal/glomerular blood vessels
leads to reduced blood flow to kidneys
ischemia develops at the kidneys
kidney loses ability to regulate whole body BP
what is the role of PTs in patients with CKD?
monitor BP in pts with DM
know their Hb1AC levels
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