Acute Renal Failure Flashcards
What is the definition of Acute Renal Failure?
Rapid decrease in GFR, resulting in Azotemia (waste build up in the blood).
Which lab values are increased in ARF?
BUN, Creatinin, Potassium, Magnesium, Phosphorus, & FESNa > 2% (Fractional excretion of Na).
Which lab values are decreased in ARF?
Hgb, hct, Na, Ca, specific gravity & albumin.
What’s the normal value of specific gravity?
1.010-1.030
What acid-base imbalance will be seen?
Metabolic acidosis d/t renal failure or DKA.
In ATN, what happens to the Na concentration in the urine?
Increases above 40 mEq.
What is normal GFR per minute and per day?
125mL/min
180L/day
GFR is measures by creatinine clearance. What is the normal value?
120-130mL/min
What are the AEIOU complications of ARF?
Acid/base problems (metabolic acidosis)
Electrolyte problems (Increased K, decreased Ca & Na)
Intoxications (meds–>intra-renal)
Overload of fluids (d/t blockages–>post-renal)
Uremic s/s (uremic frost, bruising, more prone to GI bleeds d/t increased ammonia levels).
What are the causes of Pre-Renal ARF?
Hypovolemia, cardiovascular failure/shock (25% of C.O comes from kidneys), & burns.
What is the tx of Pre-Renal ARF?
Fluids & Diuretics
What are the causes of Intra-Renal ARF?
ATN, Infection and nephrotoxic medications
What is the tx of Pre-Renal ARF?
Hemodialysis
What are the causes of Post-Renal ARF?
Blockages/Calculi
What is the tx of Post-Renal ARF?
Surgery
There are 4 phases of ATN. Name them.
Onset, Oliguric/Anuric, Diuretic, & Recovery.
How long does each phase of ATN last?
Onset: hrs-days
Olig/Anur: Anur: 5-8 days, Olig: 10-16 days
Diuretic: 7-14 days
Recovery: Weeks-months
How much fluid should the patient be losing in the diuretic phase?
2-4L/day, or at least 400ml/24hrs
In what phase of ATN do the kidneys lose ability to concentrate urine?
Diuretic b/c they’re filtering fluid very quickly.
What are the 4 types of Renal Replacement Therapy?
Hemodialysis, Peritoneal Dialysis, CVVH (Continuous Venovenous Hemofiltration) & CVVHD (Continuos Venovenous Hemodialysis).
What are the indications & advantages of Peritoneal Dialysis?
Indicated for CHRONIC kidney failure, HD unstable or bleeding patients when vascular access is difficult.
Advantages: ambulatory, slow, no anticoagulants needed.
What are the disadvantages of Peritoneal Dialysis?
Less predictable fluid removal b/c it drains by gravity with implanted catheter. May cause peritonitis r/t catheter infxn, needs to sleep sitting up (drains by gravity), increased risk of hyperglycemia, must empty colon first.
When is a temporary dialysis catheter indicated? Where is it placed?
Indicated for emergency HD or new onset of ARF or failed access.
Can be placed in IJ, Subclavian, or Femoral artery.
When is a tunneled catheter indicated?
For chronic kidney disease patients awaiting permanent access, so it can be for long-term use.
What the difference between an AV fistula and an AV graft?
A fistula is when the artery and vein is surgically connected. It needs time to mature. Nrs must assess for bruits & thrills.
A graft is made from synthetic material to create the connection between the artery and vein. No maturation time needed.
Neither of these access types are allowed BP or blood draws.
How does continuous venovenous hemofiltration (CVVH) work?
Removes solutes & fluid via convection (“Solvent drag”),
large amounts of fluid can be removed; increased pressure through the filter. It runs over 24hrs and is indicated for diuretic resistant fluid overloaded patients.
