Acute Kidney Injury and Chronic Kidney Disease Flashcards
What is kidney disease?
- kidney disease may cause the partial or complete impairment of kidney function
- results in an inability to to excrete metabolic waste products and water
- renal insufficiency impacts all body systems
What is acute kidney disease characterized by?
An abrupt decline in kidney function
How long does acute kidney disease occur over?
Over hours to days
What does acute kidney disease result in?
A build up of waste products in your blood and affects fluid balance
What are pre-renal injuries?
- injuries that occur before the kidney
What is pre-renal ischemia?
- hemorrhage or dehydration
- decreased cardiac output
- hypotension from septic shock
- antihypertensive medications
What are intrarenal injuries?
- conditions that cause direct damage to kidney tissue
What is acute tubular necrosis?
- ischemia and high pressure within the kidney causes death of tubular epithelial cells that form the renal tubules of the kidneys
What is acute glomerulonephritis?
An infection
What are some diseases that cause vascular changes?
- diabetes
- hypertension
What are post-renal injuries?
- obstructive problems
- urinary and renal calculi
- benign prostatic hypertrophy
- urethral stricture
- trauma
- bladder cancer
What is the oliguric phase of kidney injury?
- urinary output decreased to <400 ml per 24 hours
- increase in blood urea nitrogen (BUN) and creatinine levels
- uric acid, potassium, and magnesium levels
- duration 1-3 weeks
- metabolic acidosis
What is the diuretic phase of kidney injury?
- often has a sudden onset within 2-6 weeks of oliguric phase
- diuresis: up to 4-6 L per 24 hours - very dilute
- hypovolemia and hypotension
- BUN levels stop increasing
- urinary creatinine clearance stabilizes
- monitor for hypokalemia and hyponatremia
What is the recovery phase (convalescent phase) of kidney injury?
- begins when the glomerular filtration rate (GFR) increases and starts to return to normal
- continue to monitor electrolytes
- continue to monitor for hypovolemia and hypotension
- often some permanent loss of kidney function
What are some of the symptoms of acute kidney injury?
- hypotension - will become hypertensive as more fluid builds up
- irregular heart rhythms (hyperkalemia)
- SOB (fluid may back up into the lungs)
- decreased LOC: confusion to coma
- edema - fluid retention
- electrolyte imbalances (hyperkalemia and hyponatremia)
- anemia (low erythropoietin levels) - fatigue and weakness
What is the glomerular filtration rate in acute acute kidney injury?
- 90-120 mL/min/1.73 m2
- as GFR rises, urine output decreases
What diagnostic studies should be done for acute kidney injury?
- ultrasound of kidneys
- CT scan (no contrast)
What is the treatment for acute kidney disease?
- focus on determining the cause
- fluid balance
- monitor electrolytes (potassium, sodium, phosphate and calcium)
- maintain serum pH levels (administer bicarbonate)
- dialysis
What are the nursing interventions for acute kidney injury?
- monitor kidney function (BUN and creatinine values)
- accurate intake and output
- daily weights (same scale, same time)
- monitor specific gravity values
- monitor electrolyte values
- frequent vital signs (monitor BP, hypotension or hypertension)
What nursing interventions should be done in the oliguric phase?
- fluid restrictions
- hyperkalemia (give insulin and glucose help to drive K+ into the cells, sodium polystyrene sulphurated (kayexalate) - bind potassium)
- calcium supplements
- phosphate binders
- restrict protein, potassium, and sodium intake
- increased intake of carbohydrates
- monitor for constipation
What nursing interventions need to be done in the diuretic phase?
- administer fluids NS
- hypokalemia - potassium supplements
- skin care
- monitor sodium levels - hyponatremia
- monitor calcium and phosphate level
- encourage fluids
- some potassium, sodium and protein intake, check lab values
- increased intake of carbohydrates and fats for energy
- small frequent meals
What is chronic kidney disease?
- a progressive irreversible reduction in renal function
- defines as the presence of kidney disease (pathological abnormalities)
- nephrons are destroyed = decrease in glomerular filtration rate (GFR)
- normal GFR = 125ml/min/1.73m3
- chronic kidney disease GFR <60ml/min/1.73m3 for three months or longer
What are the risk factors for chronic kidney disease?
- chronic hypertension
- diabetes (poorly controlled)
- chronic glomerulonephritis or pyelonephritis
- exposure to nephrotoxic medication/chemo
- systemic lupus erythematous (SLE)
What is stage 1 of chronic kidney disease?
- kidney damage with normal GFR
- GFR >90ml/min/1.73m3
- diagnosis and treatment
- evaluation of risk factors, implement strategies to manage
- slow progression - proper nutrition, fluid management (water), meds, are prescribed
What is stage 2 of chronic kidney disease?
- kidney damage with mild decrease in GFR
- GFR = 60-89 ml/min/1.73m3
- diagnosis and treatment
- evaluation of risk factors, implement strategies to manage
- slow progression - proper nutrition, fluid management (water), meds as prescribed
What is stage 3 of chronic kidney disease?
- kidney damage with moderate decrease in GFR
- GFR = 30-59 ml/min/1.73m3
- treatments to slow progression - proper nutrition, fluid management (water), meds as prescribed)
- assess and treat complications
- example; hypertension, fluid volume overload
What is stage 4 of chronic kidney disease?
- kidney damage with severe decrease in GFR
- GFR = 15-29 ml/min/1.73m3
- treatments to slow progression - proper nutrition, fluid management (water), meds as prescribed
- assess and treat complications (DM and hypertension)
- prepare for kidney replacement therapy
What is stage 5 of chronic kidney disease?
- kidney failure
- GFR = < 15 ml/min/1.73m3
- dialysis (perineal dialysis or hemodialysis)
- kidney replacement (transplant)
What are the signs and symptoms of chronic kidney disease?
- changes in urine specific gravity
- urine - proteinuria, presence of casts, pyuria, and hematuria
- oliguria leads to anuria (<100ml of urine/24 hours)
- decreasing GFR rates over periods of months
- increasing BUN and creatinine levels
- decreasing erythropoietin production (slowly over time)
What are the metabolic changes associated with chronic kidney failure?
- accumulations of waste products (nitrogenous) impact GI system
- nausea and vomiting
- anorexia
- insulin is excreted by the kidneys - lack of filtration leads to changes in carbohydrate metabolism (elevated triglyceride levels and decreased lipase levels(breakdown fats)
- advanced stages lead to gastritis and peptic ulcer disease from metabolic acidosis
What are the respiratory systems associated with chronic kidney disease?
- dyspnea, fluid overload
- pulmonary edema
- predisposed to respiratory infections
What are the endocrine symptoms of chronic kidney disease?
- unable to filter phosphorus (commonly found in foods) = hyperphosphatemia = hypoglycemia
- demineralizing of the bone: pathological fractures
- imbalances in electrolytes impact muscle - weakness and fatigue
What are the symptoms of the skin caused by chronic kidney disease?
- yellow/gray discoloration
- pruritis (due to high level of urea)
- ecchymosis
What are the cardiovascular symptoms related to chronic kidney disease?
- hypertension
- heart failure (can develop)
- anemia (low erythropoietin production) = poor oxygenation to tissues
- hyperkalemia leads to cardiac dysrhythmia
What are the neurologic symptoms related to chronic kidney disease?
- general nervous system depression
- peripheral neuropathy
- sleep disturbances
What diagnostic tests can be done for chronic kidney disease?
- urinalysis (sediment for casts, protein, specific gravity)
- lab (BUN and creatinine levels, GFR, electrolytes, CBC: red blood cells, hemoglobin, and hematocrit values)
- ultrasound of kidneys
- CT scan
What nutritional therapy needs to be considered for patients with chronic kidney disease?
- limit protein intake to 20-40 grams/day (protein with high biologic value (high in amino acids), beef, fish and eggs)
- fluid restrictions 1L/day - adjust per urinary output or dialysis
- restrict sodium, potassium, and phosphate intake
What medications might be given for someone with chronic kidney disease?
Antihypertensive medications
- beta blockers (carvedilol, metoprolol)
- ACE inhibitors (lisinopril, ramipril)
-calcium channel blockers (amloodipine, nicardipine)
- calcium supplemental vitamin D
- phosphorus binders (calcium acetate, sevelamer)
Diuretic Medications
- loop (furosemide)
- thiazide (hydrochlorothiazide)
- potassium sparing (spironolactone
Erythropoietin (eopgen, procrit) - stimulates red blood cell development
Folic acid and or iron supplement (prevent anemia)
What nursing interventions need to be done for patients with chronic kidney disease?
- evaluate fluid balance (determine daily weights, monitor intake and output, fluid restrictions)
- monitor nutritional intake (limit sodium, phosphorus and potassium)
- prevent constipation (add bran/fiber to diet, stool softeners)
- frequent vital signs (monitor hypertension)
- medication therapy
- monitor for signs of fluid overload
- treat complications (dry skin, anemia)
- care of accesses for dialysis procedures
What is dialysis?
- passage of ions from and area of high concentration to low concentration across a semipermeable membrane
hemodialysis or peritoneal dialysis
