Ch. 34 Acute Kidney Injury, Chronic Kidney Disease and Renal Failure Flashcards
Renal Failure
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.
Actue renal failure
abrupt in onset
often is reversible if recognized early and treated appropriates
Chronic renal failure
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
Acute Kidney Injur
caused by: decreased blood flow, ischemia, toxic effects, obstruction, obstruct urine outflow.
Prerenal cases of Acute renal injury
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
Four phases of Acute Renal injury
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.
Intrinsic or Intrarenal causes of acute renal injury
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.
Postrenal causes of acute renal injury
bilateral ureteral obstruction
bladder outlet obstruction. :stone, tumor, prostate.
from the ureter all the way down.
it has to be bilateral.
Chronic Kidney Disease
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
End Stage Renal Disease
requires some kind of renal replacement therapy for life to continue. (dialysis)
Kidney Failure and ESRD
kidney failure is not synonymous with end stage renal disease
Stage of progression of chronic kidney disease
kidney failure with a GFR < 15 with a need for replacement.
Clinical manifestations of chronic renal failure
HTN, Heart failure, edema, pericarditis, hyperkalemia, pericarditis, anemia, bleeding, acidosis, osteodystrophies, sexual dysfunction, neurologic manifestations, GI manifestations, skin disorders, impaired immune function
Factors determining the manifestations of renal failure
: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
Disorders of Water, Electrolyte and Acid-Base Balance
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
Hematologic disorders accompanying renal failure
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.
CV disorders accompanying renal failure
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.
Altered Drug metabolism in kidney disease
CKD and its treatment can interfere with the absorption, distribution and elimination of drugs. . may need to alter dosage.
Altered drug absorption
antacid treatment
altered drug metabolism
results of less protein bound drugs.
increased intermediate of drug metabolism.
Nephrotoxic Drugs
NSAIDS, metformin
Treatment During the Renal Insufficiency Stage of Renal Failure
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
Treatment of Renal failure
Dialysis: hemodialysis (filters blood) and peritoneal dialysis
Transplantation
Peritoneal Dialysis
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.
Transplant kidney
new kidney is attached to the iliac artery and in a new place.
major component in the treatment of CKD
nutritional management.
dietician in their care. manage their proteins. limit water intake. calories are very important.
