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Pathophysiology 212 > Acute renal failure & Chronic kidney disease > Flashcards

Acute renal failure & Chronic kidney disease Flashcards

1
Q

When Kidneys Fail

A
  1. Poor filtration of blood
    - Waste buildup
    - Electrolyte imbalances
    - Acid/base balance
  2. Blood volume/BP changes
  3. Decreased activation of Vit D
  4. Decreased erythropoietin
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2
Q

Prerenal Failure Causes

A

Due to decreased blood flow to kidney

  • Hypovolemia
  • Heart failure, cardiogenic shock
  • Sepsis
  • Medications, toxins

Reversible if caught early!

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3
Q

Prerenal Failure Manifestations

A
  • Marked decrease in urinary output
  • Elevation of BUN in proportion to creatinine to 20:1 (normal is 10:1)- more nitrogenous waste
    BUN is not excreted as much
  • Azotemia: most common indicator of ARF
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4
Q

Intrinsic Renal Failure

A

Disorder within kidney structure

  • Prolonged ischemia
  • Injury to tubular structures
  • Intratubular obstruction
  • Infection
  • Nephrotoxic agents
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5
Q

Radiocontrast Agents

A

Giving N-acetylcysteine reduces ARF risk by 50%

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6
Q

Acute Tubular Necrosis

A

Destruction of tubular epithelial cells
d/t sepsis, nephrotoxins, medications, obstruction, infection
- Coagulation process * rbc lysis = crystals, toxins
- Results in hypoxia & ischemia
- Often reversible!

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7
Q

Acute Tubular Necrosis - 3 phases

A
  1. Onset Phase (hours to days)
  2. Maintenance Phase
    - Marked decreased GFR & urinary output
    (edema, pulmonary congestion, HTN)
    - Retention of urea/K+/sulfate, creatinine
    CNS symptoms due to toxin build up
  3. Recovery Phase
    - Gradual increased output
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8
Q

Postrenal Failure

A

Obstruction of urine output

  • Ureter (calculi, strictures)
  • Bladder (tumors, neurogenic bladder)
  • Urethra (BPH-common)
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9
Q

Treatment of all types of Renal Failure

A
  • Prevention!
  • Early diagnosis!
  • Fluids – be careful!
  • Electrolytes
  • Calories
  • Dialysis
  • Continuous renal replacement therapy
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10
Q

Chronic Kidney Disease

A

Stage 1
Kidney damage
Decreased GFR

progress to…

Stage 5
Kidney failure
Minimal GFR

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11
Q

Chemical Changes in Renal Failure

A 
ALL INCREASE
K
Cl
H+
Mg 
NH4
PO4
PTH

ALL DECREASE
EPO
Vit D
Calcium

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12
Q

Clinical Manifestations of Chronic Kidney Disease

A
  1. Altered Fluid & Electrolytes
    - Dehydration or fluid overload
    - Sodium/salt wasting (late stage)
    - Hyperkalemia (release d/t trauma, acidosis)
  2. Altered Acid-Base Balance
    - H+ ion buildup
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13
Q

Clinical Manifestations of Chronic Kidney Disease (3, 4, 5, 6)

A
  1. Vitamin D deficiency
  2. Bone Disease
    - Decreased calcium absorption (d/t Vit D deficiency) increases PTH, breaking down bone
  3. Anemia (common and early sign)
    - d/t chronic blood lsoss, hemolysis, impaired erythropoietin, iron deficiency
  4. CV Complications
    - HTN (increased PVR- peripheral cascual resistance, increased RAAS)
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14
Q

Clinical Manifestations of Chronic Kidney Disease (7, 8, 9)

A
  1. Accumulation of nitrogenous wastes
    - azotemia: elevated BUN (early sign)
    - uremia
  2. Impaired drug elimination
  3. Integument (d/t platelet dysfunction)
    - Platelet dysfunction = bruising, pruritis
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15
Q

Cardiovascular Consequences of RF

A 
Decreased blood viscosity
\+
Increased blood pressure
\+
Decreased oxygen supply
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16
Q

Management of Chronic Kidney Disease

A
  1. Dialysis
    - Hemodialysis
    - Peritoneal dialysis
  2. Dietary management
  3. Transplantation
17
Q

Hemodialysis & side effects

A
  • Allows all molecules (except for blood cells and plasma proteins) to move from blood to dyalysate and back
  • 2-4 x/week for 3-4 hours
    Side-effects
  • Hypotension, chest pain (d/t fluid shift)
    note: weight-gain common between treatments.
  • Nausea, vomiting
  • Cramps, “restless leg”
  • Dialysis disequilibrium syndrome (DDS)
18
Q

State the basis for adverse drug reactions in patients with chronic kidney disease.

A
  • CKD can interfere with the absorption, distribution, and elimination of drugs.
  • a decrease in plasma proteins (albumin) in people with CKD results in less protein-bound drug and greater amounts of free drug which can lead to toxicity.
19
Q

Compare hemodialysis with peritoneal dialysis.

A
  1. Hemodialysis: blood moves from an artery through the tubing and blood chamber in the dialysis maching and then back into the body through a vein.
  2. Peritoneal Dialysis: a catheter is tunneled through subcutaneous tissue and exits on the side of the abdomen. dialysis involves instilling a sterile dialyzing solution through the catheter over a period of 10 mins. the solution is then allowed to remain in the peritoneal cavity for a prescribed amount of time.
20
Q

State the goals for dietary management of persons with chronic kidney disease.

A

A diet rich in fruits and vegetables and low in highly acidic animal meats slows the progression of kidney disease, significantly reducing the risk of kidney failure

Pathophysiology 212 (18 decks)

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