Ch. 26 Acute Renal Failure & Chronic Kidney Disease

Question 1

What four things happen when kidneys fail?

Answer 1

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

Question 2

What results from poor filtration of blood?

Answer 2

Waste buildup
Electrolyte imbalances
Acid/base imbalances

Question 3

What causes prerenal failure?

Answer 3

Due to decreased blood flow to kidney

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

Question 4

What are the manifestations of prerenal failure?

Answer 4

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

Question 5

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

Answer 5

10:1

Question 6

What is the most common indicator of acute renal failure?

Answer 6

Azotemia

Question 7

What is azotemia?

Answer 7

The buildup of nitrogenous waste in the blood.

Question 8

What is intrinsic renal failure?

Answer 8

A disorder within the kidney structure.

Question 9

What are some causes of intrinsic renal failure?

Answer 9

Prolonged ischemia
Intratubular obstruction
Infection
Injury to tubular structures
Nephrotoxic agents

Question 10

What is acute tubular necrosis?

Answer 10

Destruction of tubular epithelial cells

Question 11

How does acute tubular necrosis happen?

Answer 11

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

Question 12

What are the three phases of acute tubular necrosis?

Answer 12

Onset phase
Maintenance phase
Recovery phase

Question 13

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

Answer 13

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

Question 14

What occurs during the maintenance phase of acute tubular necrosis?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Edema, pulmonary congestion, HTN

Question 17

What occurs during the recovery phase of acute tubular necrosis?

Answer 17

Gradual increased output

Question 18

What is postrenal failure?

Answer 18

Obstruction of urine output.

Question 19

What are the treatments for renal failure?

Answer 19

Fluids (careful)
Electrolytes
Calories
Dialysis
Continuous renal replacement therapy

Question 20

What are causes of postrenal failure in the ureter?

Answer 20

Calculi, strictures

Question 21

What are the causes of postrenal failure in the bladder?

Answer 21

Tumors, neurogenic bladder

Question 22

What are the causes of postrenal failure in the urethra?

Answer 22

Benign prostatic hypertrophy

Question 23

What chemicals increase during renal failure?

Answer 23

K
Cl
H
g
NH4
PO4
PTH (parathyroid hormone)

Question 24

What chemicals decrease during renal failure?

Answer 24

Ca
EPO
Vitamin D

Question 25

What are the clinical manifestations of chronic kidney disease?

Answer 25

``` 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 ```

Question 26

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

Answer 26

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

Question 27

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

Answer 27

Hydrogen ions build up

Question 28

How does chronic kidney disease cause bone disease?

Answer 28

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

Question 29

How does chronic kidney disease cause anemia?

Answer 29

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

Question 30

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

Answer 30

HTN (intreased peripheral vascular resistance, increased RAAS)

Question 31

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

Answer 31

Elevated BUN

Question 32

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

Answer 32

Platelet dysfunction = bruising, pruritis

Question 33

What are two types of dialysis?

Answer 33

Hemodialysis | Peritoneal dialysis

Question 34

What are ways to manage chronic kidney disease?

Answer 34

Dialysis Dietary management Transplantation

Question 35

What is hemodialysis/how does it work?

Answer 35

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.

Question 36

How often does hemodialysis need to be done?

Answer 36

2-4 times a week for 3-4 hours

Question 37

What are the side effects of hemodialysis?

Answer 37

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