Acute Kidney Injury & Chronic Kidney Disease (Ch. 34)-- Definition First Flashcards
1
Q
- Loss of ability to regulate Na+
- Early CKD: Na+ & H2O loss
- Late CKD: Na+ & H2O retention → Edema & HTN
- 90% of K+ renally eliminated
-
⇡ Hyperkalemia risk → Dysrhythmias
- Dialysis (@ least 4 hrs.)
-
⇡ Hyperkalemia risk → Dysrhythmias
-
⇣ Ability to eliminate H+ & resorb HCO3-
- Metabolic acidosis
A
CKD Fluid & Electrolyte Manifestations
2
Q
- ⇡ Morbidity (illness) and mortality (death)
- 10-20X higher
- ⇡ Blood volume → HTN
- Dyslipidemia → Vascular disease
- Ischemic heart disease
- HF
- Stroke
- Peripheral vascular disease
A
CKD Cardiovascular Manifestations
3
Q
Multiple systemic effects related to loss of GFR and endocrine functions
- ⇣ Kidney function
-
⇣ GFR
- <60 mL/min for 3 months +
- ⇣ Ion, electrolyte, and H2O resorption
- ⇣ Endocrine functions
-
⇣ GFR
-
Azotemia (nitrogenous waste in blood)
- ⇡ BUN & ⇡ SCr
-
Uremia (urine in blood)
- ⅔ of Nephrons destroyed
-
Uremic encephalopathy
- Pruritis
- N/V
- Weakness/fatigue
- ⇡ BP
- ⇣ Erythropoiesis
- Impaired Vit. D synthesis
A
Chronic Kidney Disease (CKD) Clinical Manifestations
4
Q
- Kidneys unable to excrete phosphorus
- ⇡ Phosphorus & ⇣ Ca2+ → ⇡ PTH → ⇡ Ca2+ resorption from bone
-
Impaired Vit. D Synthesis
-
⇣ Vit. D → ⇡ PTH & ⇣ Ca2+ intestinal absorption
- Osteoporosis
- Osteomalacia
- ⇡ Fracture risk
-
⇣ Vit. D → ⇡ PTH & ⇣ Ca2+ intestinal absorption
-
Protein, CHO, & Fat metabolic changes
- ⇣ Serum protein → ⇣ Muscle mass & ⇣ Colloidal osmotic pressure → Edema
- Insulin resistance & glucose intolerance → DM
- Dyslipidemia
A
CKD Metabolism Manifestations
5
Q
- Dietary restrictions
- ⇣ Protein, Na+, K+ & Phosphate
- Vit. D supplementation
- Fluid balance/restriction
- Glucose control (DM)
- Medications
-
ACE-Is & ARBs
- Dilate efferent arteriole
-
ACE-Is & ARBs
- End-stage renal failure
- Renal replacement therapy
- Peritoneal dialysis
- Hemodialysis
- Kidney transplant
- Renal replacement therapy
A
Chronic Kidney Disease Management
6
Q
End result of kidney damage, develops slowly– IRREPARABLE
A
Chronic Kidney Disease (CKD)
7
Q
- Anemia
-
⇣ Erythropoiesis → Iron deficiency & ⇣ RBCs
- Weakness, fatigue, HA, irritability, depression, insomnia, ⇣ cognitive function
- ⇣ Blood viscosity → ⇡ HR & Peripheral vasodilation
- ⇣ Myocardial O2 → Angina, ischemic cardiac events
-
⇣ Erythropoiesis → Iron deficiency & ⇣ RBCs
-
Dialysis damages platelets
- ⇣ or impaired platelets → bleeding
- ⇡ Risk of thrombotic disorders
A
CKD Hematologic Manifestations
8
Q
- ⇡ Blood volume → Pulmonary edema & HTN
-
Kussmaul respirations
- Hyperventilation
- Compensatory mechanism for metabolic acidosis
A
CKD Pulmonary Manifestations
9
Q
-
Structural damage within kidney
- Glomeruli
- Vessels
- Tubules
- Interstitium
-
Acute tubular necrosis → Sudden ⇣ in renal blood flow
- Prerenal injury
- Intratubular obstruction
- Acute renal disease
- Drug nephrotoxicity
- Toxins from infections
A
Intrarenal AKI
10
Q
-
Altered immune function
- ⇡ Infection risk
-
Altered CNS & PNS Function
- Peripheral neuropathy
- Restless leg syndrome
- Uremic encephalopathy
-
Sexual dysfunction
- Impotence
- Hypofertility
- Dysmenorrhea
-
Disorders of skin integrity
- Pale, sallow, grey skin
- Dry/scaly skin and mucous membranes
- Bruising
A
Other CKD Manifestations
11
Q
Abrupt injury to the kidneys, w/i 48 hrs.– REVERSIBLE (if treated early)
A
Acute Kidney Injury (AKI)
12
Q
- Shock
- Hypovolemia
- HF w/ ⇣ CO
-
Intrarenal vasoconstriction
- Contrast media
- Cyclosporine
- NSAIDS
A
Prerenal AKI Causes
13
Q
- Kidneys fail to
- Remove metabolic waste from the blood
- Regulate fluid, electrolyte, & pH balance of ECF
-
Loss of endocrine function
- Renin
- Erythropoietin
A
Renal Failure
14
Q
- Most common
- 25-80% mortality rate
-
Sudden ⇣ in renal blood flow → Ischemic tubular necrosis
-
⇣ GFR (<25% of normal)
- Normal GFR: 120-130 mL/min
-
Sharp ⇣ urine output
- Acute, early sign
-
⇡ BUN : SCr
- 10:1 (normal) → 20:1 (elevated)
-
⇣ GFR (<25% of normal)
A
Prerenal AKI
15
Q
-
Initiation
- No S/S for hrs. or days
- ⇣ GFR
- ⇡ BUN
-
Maintenance
- 1-2 weeks
-
Oliguria + ⇣ GFR
- <20 mL/hr
- Metabolic waste accumulation
- Edema
- Pulmonary congestion
- HTN
- Uremia
-
Recovery
- Repair of renal tissue
-
Excessive diuresis
- 1-2 L/day
- First sign
- ⇡ GFR & urinary output
- ⇣ SCr & BUN
A
Intrarenal AKI Clinical Manifestations