Advanced Renal Concepts and TPN Flashcards
Factors which decrease GFR: Afferent
Vasoconstriction d/t NSAIDS
Factors which increase GFR: Afferent
Vasodilation d/t Prostaglandin or ANP (Atrial Natriuretic Peptide)
Factors which decrease GFR: Efferent
Vasodilation d/t prostaglandin
Factors which increase GFR: Efferent
Vasoconstriction d/t ANP (Atrial Natriuretic Peptide), Angiotensin 2, Norepinephrine
What are the 9 major functions of the kidney?
Regulate body fluid/fluid volume Regulate elimination of Na, K, Ca, P04 Regulate osmolality of ECF (extra cellular fluid) by action of ADH (anti-diuretic hormone) BP regulation Maintain pH Eliminate metabolic waste Eliminate drugs Activate Vitamin D Produces erythropoietin
What is BUN and the normal range?
Urea is the product of protein metabolism
Readily filtered out by the kidneys, some may be reabsorbed
Range: 62-102 in male and 53-97 in females
What is Creatinine and the normal range?
Byproduct of of muscle function
Readily filtered out by the kidneys, some may be reabsorbed
Range: 2.1-7.1
BUN/Creatinine Ratio
10:1- 20:1
BUN is higher than creatinine as more is reabsorbed
Glomerular FIltration Rate
125ml/minute
Uses Creatinine clearance, collected via 24 hour urine
Not considered reliable as creatinine filtration is variable
eGFR
an estimate of GFR based on sex, gender, race, and weight
Normal Urine Output
1500ml/day = 30ml/h
Normals for Urinalysis
pH, protein, glucose, ketones, specific gravity, casts, leukocyte esterase, bilirubin, urobilinogen
pH: 5.0-6.5
protein :
Stage 1 Kidney Failure: GFR
90-120
Stage 2 Kidney Failure: GFR
60-90
Stage 3 Kidney Failure: GFR
30-60
Stage 4 Kidney Failure: GFR
15-30
Stage 5 Kidney Failure: GFR
0-15
What is the RIFLE Criteria for GFR?
Risk: No damage to kidney yet, only risk. Increased creatinine X1.5 or GFR decrease>25%
Injury: Some damage to kidneys, may be repairable, may not be. Increased creatinine X2 or GFR decrease>50%
Failure: Definite failure, injury, may be repairable, may not be. Increased creatinine X3 or GFR decrease >75%
Loss: The damage will affect the entire body and will not be regained. Persistent ARF = complete loss or renal function >4 weeks
ESRD: The damage will affect the entire body and will not be regained. End stage renal disease
1st Stage of Renal Failure: Prodromal Phase
Early symptoms, beginning of renal failure, may not have any symptoms yet. Injury has occurred, normal or decreased urine output , increased BUN and creatinine
2nd Stage of Renal Failure: Oliguric Phase (a few)/Anuric (none) [1-2 weeks]
Oliguria/anuria, volume overload, hyperkalemia, azotemia/uremia, metabolic acidosis, high potassium, decreased sodium, decreased hemoglobin (Not making erythropoietin), Not making bicarb
3rd Stage of Renal Failure: Recovery Phase (Up to 1 year)
Fluid volume deficit, labs begin to normalize, kidneys not functioning properly
Acute Renal Failure Types: Pre-renal
R/t blood and 02 content not reaching the kidney. Caused by transient renal hypoperfusion due to :
Hypotension: decreased cardiac output
Decreased effective arterial blood volume