Exam 2: CKD and Pyelonephritis Flashcards
What is the best approximation of renal function?
24 hour urine (creatinine clearance)
Detects and evaluates progression of kidney disease
GFR
Should be >125
Stage 4: Plan for dialysis
Stage 5: Need dialysis
Chronic kidney disease
Kidney damage or a decrease in GFR for 3 or more months
Decreased quality of life, can progress to ESKD
Manifestations: Increased creatinine, anemia (not making erythropoietin), fluid retention, electrolyte imbalances
Interventions: Treat underlying cause, keep BP below 130/80, control cardiac risk factors, referral to RRT (renal replacement therapy), education
Glomerulonephritis
Post strep infection, inflammation of glomerular capillaries
Manifestations: Hematuria, edema, azotemia, proteinuria, cola-colored urine, HTN
Treatment: Corticosteroids, manage HTN, ABX if infection still present (use cautiously = nephrotoxic), I&O, fluids as needed
Nephrotic Syndrome
Increased glomerular permeability leading to MASSIVE PROTEINURIA
Hypoalbuminemia, hyperlipidemia, hypercoaguable state, edema, frothy urine
Treatment: Diuretics, ACE-inhibitor, lipid-lowering agents, sodium restriction
End-Stage Kidney Disease (ESKD)
Stage 5 CKD, RRT on permanent basis required
Manifestations: Uremia, metabolic acidosis (unable to excrete acid), asterixis (flappy hand), confusion, anger, change in MS, dry flaky skin, fluid retention, hyperkalemia, HTN, edema, crackles, SOB, anorexia, anemia, thrombocytopenia, fractures
Treatment: Calcium and phosphate binders given with meals, antihypertensives, inotropics (digoxin), erythropoietin
ESKD Complications
Anemia
Calcium-phosphorous imbalance
Hyperkalemia
HTN
Pericarditis, pericardial effusion, pericardial tamponade
Renal Replacement Therapy (RRT)
Used when kidneys can no longer remove wastes, maintain electrolytes, and regulate fluid balance
Can be needed acutely or chronically
Dialysis (Hemodialysis)
Used short and long term
Goal: Extract toxic nitrogenous substances from the blood and remove excess fluid
Indications: Acid-base problems/acidosis, electrolyte imbalances, intoxications, overload of fluid, uremic symptoms
Access:
AV fistula = Preferred, vein to artery, limb alert
Arteriovenous graft = synthetic connection vein to artery
HD catheter = double-lumen, only dialysis RN can touch this
Complications: Bleeding, hypotension
Continuous Renal Replacement Therapy (CRRT)
Continuous HD for patient too unstable for HD
Can be run on a critical care unit by ICU RN
Run through dialysis catheter
Able to remove small amounts of fluid over days
Peritoneal Dialysis
Self-care patients, can perform at home
Anything that goes in has to come out, can have PT turn side to side, do not manipulate catheter
Procedure: PD catheter inserted in abdomen, dwells dialysate into peritoneum drainage of dialysate into drainage bag
Complications: Peritonitis, leakage, bleeding
Kidney Disease Risk Factors
Advanced Age
BPH
Diabetes
Gout, hyperparathyroidism, Crohn’s, ileostomy
HTN
Immobilization
Exposure to chemicals/toxins
Incontinence
Pregnancy
Pelvic surgery
SCI
Strep throat
Immunocompromising diseases
ESKD Nutritional Considerations
Dietician referral
Regulation of protein and fluids
Decreasing protein decreases workload on kidneys
Restriction of potassium and sodium
If on HD: Need high-biologic protein (eggs, meat, fish), fluid restriction 1000 ml/24 hours
Pyelonephritis
Bacterial infection of renal pelvis, tubules, and interstitial tissue of one or both kidneys
Causes: Bladder infection, incompetent ureterovesical valve or obstruction in urinary tract, bladder or prostate tumors, strictures, BPH, urinary stones, systemic infections
Complications: Sepsis, dehydration, nausea, vomiting
Management: Antibiotics up to 6 weeks, oral and parenteral hydration, treatment of underlying cause
Clinical manifestations: Chills, fever, leukocytosis, bacteriuria, pyuria, low back pain, flank pain, n/v, headache, malaise, painful urination, CVA pain, urinary urgency/frequency
Chronic Pyelonephritis
Multiple bouts of acute pyelonephritis, usually asymptomatic until exacerbation
Cause the kidney to become scarred, contracted, and non-functioning, cause of CKD
Manifestations: Fatigue, headache, poor appetite, polyuria, excessive thirst, weight loss
Complications: ESKD, hypertension, renal calculi
Management: Prophylactic antimicrobials, monitor for nephrotoxicity, antibiotics if bacteria in urine, I&O, 3-4 L of fluid/day, VS Q4 hours, empty bladder completely, perineal hygiene
