Chapter 34 Acute Renal Injury and Chronic Kidney Disease Flashcards
What are the causes for acute renal failure?
Prolonged renal ischemia, ischemia from surgery, trauma, blood loss, exposure to nephrotoxic drugs, an intratubular obstruction
If blood pressure goes down how does that affect glomerular filtration and what happens?
glomerular filtration would decrease, then the kidneys would not be able to work as well
how does an intratubular obstruction affect the kidneys and what can cause it?
it can result in ischemia and cell death, it can result from hemoglobinuria (blood cells lysing) myoglobinuria (muscle protein released due to trauma to muscle cells) or high uric acid
what is azotemia?
high nitrogen in the blood
does acute renal failure have an abrupt or delayed onset?
abrupt
what happens during renal failure?
the kidneys fail to remove metabolic end products/wastes from the blood, fail to regulate fluid electrolyte and pH balance
Is acute renal failure reversible?
yes if it is recognized early and then treated
What can cause acute renal failure?
decrease in renal blood flow from hypovolemia, glomerulonephritis, and renal obstruction
What is a treatment for acute renal failure?
dialysis
What is chronic renal failure and how is it different from acute renal failure?
slow onset, usually over the course of years, the end result is irreparable damage to the kidneys.
What causes chronic renal failure?
Associated with systemic diseases like, HTN, diabetes, obstruction of urinary tract, cancers, autoimmune disorders, chronic use of pain meds…
What autoimmune disorder is associated with chronic renal failure?
Brights syndrome - immune system recognizes the kidney as foreign and begins to attack it.
what are the clinical manifestations of chronic kidney failure
accumulation of nitrogenous wastes = uremia, pruritis, serositis (inflammation of the serous wet membrane), alterations in electrolytes, pH, affects every body system
What are the clinical manifestations of chronic kidney failure for the skeletal system?
inability to excrete phosphates = decreased calcium - weakening of bones
you need phosphates to retain calcium
What are the clinical manifestations of chronic kidney failure for the hematological system?
decreased erythropoietin = anemia , erythropoietin tells the body you need more RBCs without them = coagulopathies from decreased platelet function
What are the clinical manifestations of chronic kidney failure for the cardiovascular system?
increased fluid volume due to not being able to excrete it = hypertension, pericarditis from toxin accumulation
What are the clinical manifestations of chronic kidney failure for the gastrointestinal system?
uremic gastroenteritis, anorexia, nausea, vomiting, metallic taste (due to increase in sodium in the blood IMPORTANT SIGN)
What are the clinical manifestations of chronic kidney failure for the neuromuscular system?
peripheral neuropathy, uremic encephalopathy (loss of coordination, confusion…)
What are the clinical manifestations of chronic kidney failure for the immune system?
immune suppression, increased risk for infection
What are the clinical manifestations of chronic kidney failure for the integumentary system?
pallor (from anemia), retained urochromes = yellow skin tone, accumulation of uric acid crystals = skin residues that leaves a white cast on the body, irritation, pruritis
What affect does chronic kidney disease have on treatment with drugs?
alterations in absorption, distribution and elimination
How does CKD alter drug absorption?
likely to stay in the body longer due to decreased functioning of the kidneys, and if you have CKD you are likely being treated for something else and that can affect drug metabolism
How does CKD alter drug metabolism?
less protein bound drugs, increased intermediates
What would treatment of renal failure look like?
slowing the deterioration of renal function, dialysis, transplantation, dietary management
What would slowing the deterioration of renal function involve as treatment for CKD?
treating UTIs promptly
avoiding renal toxic meds
controlling BP
controlling blood sugars
what are the 2 types of dialysis available for treatment of renal failure?
hemodialysis and peritoneal dialysis
What is peritoneal dialysis?
putting dialysis fluids in the abdomen then letting the peritoneum exchange it – cannot do this for long periods as it could damage the peritoneum
What dietary management would you recommend for someone with renal failure?
restricting proteins in order to reduce the nitrogenous wastes, restricted sodium, potassium, and fluid intake to avoid putting more pressure on the kidneys
Would you restrict fluids for someone with renal failure?
yes because you don’t want to put more pressure on the kidneys than is already there – just get the fluid you need and no more.
