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Pathophysiology II class notes > Ch. 26 Acute Renal Failure & Chronic Kidney Disease > Flashcards

Ch. 26 Acute Renal Failure & Chronic Kidney Disease Flashcards

1
Q

What four things happen when kidneys fail?

A

Poor filtration of blood
Blood volume/BP changes
Decreased activation of vitamin D
Decreased erythropoietin

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2
Q

What results from poor filtration of blood?

A

Waste buildup
Electrolyte imbalances
Acid/base imbalances

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3
Q

What causes prerenal failure?

A

Due to decreased blood flow to kidney

  • hypovolemia
  • heart failure
  • cardiogenic shock
  • sepsis
  • medications/toxins
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4
Q

What are the manifestations of prerenal failure?

A

Marked decrease in urinary output
Elevation of BUN in proportion to creatinine (15:1 or 20:1)
Azotemia

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5
Q

What is a normal proportion of BUN (blood urea nitrogen) to creatinine?

A

10:1

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6
Q

What is the most common indicator of acute renal failure?

A

Azotemia

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7
Q

What is azotemia?

A

The buildup of nitrogenous waste in the blood.

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8
Q

What is intrinsic renal failure?

A

A disorder within the kidney structure.

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9
Q

What are some causes of intrinsic renal failure?

A 
Prolonged ischemia
Intratubular obstruction
Infection
Injury to tubular structures
Nephrotoxic agents
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10
Q

What is acute tubular necrosis?

A

Destruction of tubular epithelial cells

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11
Q

How does acute tubular necrosis happen?

A

Sepsis, nephrotoxins, medication, obstruction, infection
Coagulation process and red blood cell lysis = crystals and toxins
Results in hypoxia and ischemia
Often reversible!

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12
Q

What are the three phases of acute tubular necrosis?

A

Onset phase
Maintenance phase
Recovery phase

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13
Q

What occurs during the onset phase of acute tubular necrosis, and how long does it take?

A

Development of acute tubular necrosis up to the time of ischemia (hours to days)

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14
Q

What occurs during the maintenance phase of acute tubular necrosis?

A

Marked decrease in GFR and urinary output. Retention of urea, K+, sulfate, creatinine

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15
Q

Why do CNS symptoms occur during the maintenance phase of acute tubular necrosis?

A

Due to the buildup of toxins in the blood during acute tubular necrosis.

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16
Q

What are the results of the marked decrease in GFR that occurs during the maintenance phase of acute tubular necrosis?

A

Edema, pulmonary congestion, HTN

17
Q

What occurs during the recovery phase of acute tubular necrosis?

A

Gradual increased output

18
Q

What is postrenal failure?

A

Obstruction of urine output.

19
Q

What are the treatments for renal failure?

A 
Fluids (careful)
Electrolytes
Calories
Dialysis
Continuous renal replacement therapy
20
Q

What are causes of postrenal failure in the ureter?

A

Calculi, strictures

21
Q

What are the causes of postrenal failure in the bladder?

A

Tumors, neurogenic bladder

22
Q

What are the causes of postrenal failure in the urethra?

A

Benign prostatic hypertrophy

23
Q

What chemicals increase during renal failure?

A 
K
Cl
H
g
NH4
PO4
PTH (parathyroid hormone)
24
Q

What chemicals decrease during renal failure?

A

Ca
EPO
Vitamin D

25
Q

What are the clinical manifestations of chronic kidney disease?

A 
Altered fluid and electrolytes
Altered acid-base balance
Bone disease
Vitamin D deficiency
Anemia
CV complications
Accumulation of nitrogenous wastes
Impaired drug elimination
Integumentary changes
26
Q

What are the alterations in fluid and electrolytes that occur during chronic kidney disease

A

Dehydration or fluid overload
Sodium/salt wasting (late stage)
Hyperkalemia (release d/t trauma, acidosis)

27
Q

Why does chronic kidney disease cause altered acid-base balance?

A

Hydrogen ions build up

28
Q

How does chronic kidney disease cause bone disease?

A

Vitamin D deficiency

Decreased calcium absorption (d/t vitamin D deficiency) increases parathyroid hormone, breaking down bone

29
Q

How does chronic kidney disease cause anemia?

A

Due to chronic blood loss, hemolysis, impaired erythropoietin, iron deficiency

30
Q

What are the cardiovascular complications that result from chronic kidney disease?

A

HTN (intreased peripheral vascular resistance, increased RAAS)

31
Q

What is an early sign of accumulation of nitrogenous wastes in the blood due to chronic kidney disease?

A

Elevated BUN

32
Q

What is the effect of chronic kidney disease on the integument?

A

Platelet dysfunction = bruising, pruritis

33
Q

What are two types of dialysis?

A

Hemodialysis

Peritoneal dialysis

34
Q

What are ways to manage chronic kidney disease?

A

Dialysis
Dietary management
Transplantation

35
Q

What is hemodialysis/how does it work?

A

Takes blood out of the body, runs it through a machine, and puts it back in the body. It allows all molecules (except for blood cells and plasma proteins) to move from blood to dialysate and back.

36
Q

How often does hemodialysis need to be done?

A

2-4 times a week for 3-4 hours

37
Q

What are the side effects of hemodialysis?

A 
Hypotension
Chest pain
Nausea, vomiting
Cramps
"restless leg"
Dialysis disequilibrium syndrome (DDS)

Pathophysiology II class notes (15 decks)

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