Acute renal injury and chronic renal failure Flashcards
acute kidney injury is
sudden and reversible syndrome caused by abrupt deterioration of kidney function over hours to weeks causing retention of nitrogenous wastes and electrolyte imbalance.
chronic kidney disease
is a long-term and progressive condition in which the kidneys gradually loose their nephrons at about 75%. Mainly caused by diabetes.
types of acute kidney injury
Prerenal (damage before the kidneys) - sudden and severe drop in blood pressure due to shock, trauma or illness which interrupts blood flow to the kidneys.
Intrarenalv (damage in the kidneys) - direct damage to kidneys caused by inflammation, toxins, drugs, infection or reduced blood supply
Postrenal (damage after the kidneys) - sudden obstruction of urine flow due to enlarged prostate, kidney stones and bladder tumor.
Causes of chronic kidney disease
HTN
diabetes
autoimmune diseases
genetic disorders
acute kidney injury signs and symptoms
oliguria
peripheral oedema
SOB - when fluid builds up in the lungs
fatigue and weakness - electrolyte imbalance
N&V - toxin buildup and electrolyte imbalance
confusion - toxin buildup and electrolyte imbalance
chest pain - fluid build up or inflammation around the pericardium
nursing treatment for acute kidney injury
CORRECT and IDENTIFY underlying cause of injury to prevent long term damage to nephrons
diet modifications - low protein diet (excess protein can put a strain on the kidneys - therefore limiting protein intake would reduce kidney workload) and LIMIT fluid intake
STRICT I&O (to monitor fluid overload <risk> and dehydration <risk>) + daily weights (measure kidney function)</risk></risk>
dialysis - until kidney function returns
lab values related to renal failure
serum creatinine - increased (produced by muscle metabolism and excreted by the kidneys)
BUN (blood urea nitrogen) - increased (the amount of nitrogen in the blood from the waste product urea which is produced from breaking down proteins
Na - normal or decreased
K+ - increased (most serious due to risk of hyperkalaemia which can lead to heart arrhythmias - advice patients to limit potassium rich diet)
Phosphorous - increased (risk of hyperphosphatemia - decreasing Ca levels)
Ca - decreased (risk of renal osteodystrophy)
stages of CKD
1 - normal kidney function GFR = >90ml/min (normal kidney function 90-120ml/min)
2 - mild kidney damage GFR = 60 - 89 ml/min
3 - moderate kidney damage = 30 - 59 ml/min
4 - severe kidney damage GFR = 15-29 ml/min
5 - end stage kidney disease GFR = <15 ml/min
CKD S&S
fatigue
confusion, lethargy and seizures
bruising
HTN, HF
N&V
weakness
nocturia and polyuria
puffy hands
muscle cramps and pain
renal osteodystrophy (bone pain)
neuropathy
peripheral oedema
urine assessment
anuria
dysuria
enuresis
polyuria
haematuria
incontinence
nocturia
oliguria
retention
Management of CKD
Prescription for peritoneal or haemodialysis
maintain BP
avoid ACE inhibitors, insulin to reduce hyperglycaemia (kidney damaging medications)
control BSL
reduce salt
maintain healthy weight
vitamin D supplementation
increase fluid intake
what is dialysis
ways to remove waste products from the blood in those with kidney dysfunction since waste accumulates and become toxic in the body.
haemodialysis
uses a dialyser or artificial kidney to remove excess waste and toxins from the blood.
brings blood to the dialyser > filters out toxins or waste products > brings back filtered blood back to the body
done 3x a week for 3-6 hours
haemodialysis access sites
fistula - joining an artery to a vein (done by inserting a synthetic graft between artery and vein)
tunnel line - catheter inserted via intra jugular vein (high risk of infection and clotting)
complications of haemodialysis
hypotension
cramps (due to electrolyte imbalances)
air embolus
