Ch. 34 Acute Kidney Injury, Chronic Kidney Disease and Renal Failure

Question 1

Renal Failure

Answer 1

condition in which the kidneys fail to remove metabolic end products from the blood and regulate the fluid, electrolyte and pH balance of the extracellular fluids
Causes: renal disease, systemic disease, urologic defects of nonrenal origin.

Question 2

Actue renal failure

Answer 2

abrupt in onset

often is reversible if recognized early and treated appropriates

Question 3

Chronic renal failure

Answer 3

end result of irreparable damage to the kidneys, it develops slowly, usually over the course of a number of years. needs to cause failure in more than 80% to see the effects

Question 4

Acute Kidney Injur

Answer 4

caused by: decreased blood flow, ischemia, toxic effects, obstruction, obstruct urine outflow.

Question 5

Prerenal cases of Acute renal injury

Answer 5

hypovolemia
decreased vascular filling
heart failure and cardiogenic shock.
decreased renal perfusion due to vasoactive mediators, drugs, diagnostic agents. 
inc in BUN and creatinine
normally 10x more BUN than creatinine

Question 6

Four phases of Acute Renal injury

Answer 6

Onset: triggering event. the longer it takes to trigger the longer it takes to heal
Oliguric phase: urine output is significantly decreased. last up to a week.
Diuretic phase: improvement in urine output. decrease in BUN and creatinine.
Recovery phase: decreased edema, return of GFR, rapid to months to years.

Question 7

Intrinsic or Intrarenal causes of acute renal injury

Answer 7

acute tubular necrosis. prolonged renal ischemia, esposure to nephrotoxic drugs, metals, organic solvents. intratubular obstruction resulting from hemoglobinuria, myoglobinuria, myeloma light chains, or uric acid casts, acute renal disease.

Question 8

Postrenal causes of acute renal injury

Answer 8

bilateral ureteral obstruction
bladder outlet obstruction. :stone, tumor, prostate.
from the ureter all the way down.
it has to be bilateral.

Question 9

Chronic Kidney Disease

Answer 9

some kind of kidney damage that one can observe. can be caused by a myriad of diseases, but the commonality is the loss of nephrons.
when GFR falls to 60 ml per minute for a 3 month period or longer, it meets the criteria.
it is not truly a disease in of itself, it is a manifestation of kidney issues related to other disease.
US: HTN and diabetic kidney disease are the largest causes.
looking for microalbunimeria

Question 10

End Stage Renal Disease

Answer 10

requires some kind of renal replacement therapy for life to continue. (dialysis)

Question 11

Kidney Failure and ESRD

Answer 11

kidney failure is not synonymous with end stage renal disease

Question 12

Stage of progression of chronic kidney disease

Answer 12

kidney failure with a GFR < 15 with a need for replacement.

Question 13

Clinical manifestations of chronic renal failure

Answer 13

HTN, Heart failure, edema, pericarditis, hyperkalemia, pericarditis, anemia, bleeding, acidosis, osteodystrophies, sexual dysfunction, neurologic manifestations, GI manifestations, skin disorders, impaired immune function

Question 14

Factors determining the manifestations of renal failure

Answer 14

:the extent of the renal function that is present
:coexisting disease conditions
:the type of renal replacement therapy that the person is receiving.
:looking at uremia (blood urine nitrogen) accumulating in the kidney

Question 15

Disorders of Water, Electrolyte and Acid-Base Balance

Answer 15

Sodium and water balance: the kidneys function in the regulation of ECV
K balance: 90% of k excretion is through kidney
Acid-Base balance: kidneys normally regulate blood pH by eliminating h ions produced in metabolic processes and regenerating hco3

Question 16

Hematologic disorders accompanying renal failure

Answer 16

anemia: chronic blood loss, hemolysis, bone marrow suppression, erythropoietin is decreased.
iron deficiency anemia.
coagulopathies: due to platelet dysfunction. does not go away. bleeding disorders. thrombotic disorder risks.

Question 17

CV disorders accompanying renal failure

Answer 17

HTN: usually the first manifestation. usually causes the disease.
Heart Disease: increase risk of ischemic heart disease and left ventricular hypertrophy. impaired ventricular systolic and diastolic function.
Pericarditis: end stage. uremia. chest pain, friction rub. due to uremia that causes inflammation.

Question 18

Altered Drug metabolism in kidney disease

Answer 18

CKD and its treatment can interfere with the absorption, distribution and elimination of drugs. . may need to alter dosage.

Question 19

Altered drug absorption

Answer 19

antacid treatment

Question 20

altered drug metabolism

Answer 20

results of less protein bound drugs.

increased intermediate of drug metabolism.

Question 21

Nephrotoxic Drugs

Answer 21

NSAIDS, metformin

Question 22

Treatment During the Renal Insufficiency Stage of Renal Failure

Answer 22

using measures to retard deterioration of renal function and assist the body in managing the effects of impaired function
:treating UTIs promptly, avoiding medication with renal damaging potential, controlling bp, controlling bs in diabetes, stopping smoking

Question 23

Treatment of Renal failure

Answer 23

Dialysis: hemodialysis (filters blood) and peritoneal dialysis
Transplantation

Question 24

Peritoneal Dialysis

Answer 24

continuous ambulatory peritoneal dialysis
automated peritoneal dialysis. (uses a machine)
catheter into peritoneal cavity and let sit for a few hours, then allow the filtrate to flow to the floor in a new bag.

Question 25

Transplant kidney

Answer 25

new kidney is attached to the iliac artery and in a new place.

Question 26

major component in the treatment of CKD

Answer 26

nutritional management.

dietician in their care. manage their proteins. limit water intake. calories are very important.