Kidney Flashcards
Normal urine
No blood cells
No plasma
No protein
Glomerular filtration rate
Rate that blood is passed through nephron
125ml/min
Factors that increase GFR
Elevated BS
Increased protein intake
Mild disease
60-89
Moderate disease
Below 60
End stage kidney disease
15 or less
BUN
End product of protein metabolism
BUN normal
10-20
Digesting blood
GI bleed
Makes BUN rise
If BUN elevated
Either have a decrease in kidney function or less fluid
Creatinine normal
0.6-1.2
Creatinine
Byproduct of anaerobic metabolism in skeletal muscle
If creatinine elevated
GFR decreased
Oliguria
400 or less in 24 hours
Anuria
100 mL or less in 24 hours
Azotemia
Build up of nitrogenous wastes in blood
Uremic frost
White crystals that appear on skin composed of urea
Prerenal
Deceased blood supply
Shock, dehydration, vasoconstriction
Intrinsic
Kidney tubule function is decreased
Ischemia, toxins, intratubular obstruction
Postrenal
Urine flow is blocked Stones Tumors Enlarged prostate Catheter
When to report urine output
Less than 0.5/kg/hr for two hours
Onset (initiation) phase of AKI
Normal perfusion is abruptly diminished-hours to days
No symptoms yet
Oliguric phase of AKI
Urine output less than 400ml/24 hours
1-7 days
Lasts 1-3 weeks
Collection of debris/wastes/h2o in tubules
Oliguric phase labs
Increased Creatinine BUN K+ Phosphorus Mag Sodium All masked by fluid retention
Diuretic phase of AKI
Movement towards recovery Starts 2-6 weeks Lasts 1-3 weeks Renal perfusion and GFR increase LARGE DILUTE URINE Risk for dehydration and electrolytes 10L/hr
Recovery phase of AKI
Convalescent phase
Takes up to a year
Damage does not grow back
Signs and symptoms of AKI
Weight gain Decreased urine output Fluid volume overload Nausea HA, confusion Cramps, twitching Dysthymia
Drug History that may lead to AKI
NSAIDS
Antibiotic
Some antifungals
Treatment for AKI
IV fluid challenge Calcium channel blockers Bicarbonate infusion Renal diet Dialysis
More drugs that hurt the kidney
Acetylcytetine
Dopamine
Diuretics
Renal diet
Stay away from
Potassium
Sodium
Phosphorus
Prevention and health maintenance
Avoid hypotension
Monitor labs
Monitor weight
Use touch nephrotoxic drugs
Nursing care in AKI
Monitor fluid balance
Labs
Maintain MAP of 65
Educate
Causes of CKD
Diabetes
HTN
AKI
Genetic
CKD
Progressive, irreversible kidney injury
GFR 15 or less
Azotemia
Uremia
Renal filtering function decreases fluid and electrolytes
Acidosis
Hyperkalemia
Hypertension
Wastes build up in blood
Toxic to CNS, RBCs, platelets
Increased creatinine and BUN
Kidney metabolic functions decrease
Erythropoietin
Vitamin D activation
No symptoms of CRF until
75-80% loss of nephrons
Chronic renal failure GFR
Less than 60ml/min for 3 months or more
CRF difficult to diagnose
Healthy nephrons enlarge to compensate
Stage 1
At risk
Greater than 90
Stage 2
Mild 60-89
Stage 3
Moderate 30-59
Stage 4
Severe 15-29
Stage 5
End stage
Less than 15
Stage 2…..
What to do?
Control risk factors
No NSAIDS
No ACE/ARBS
What happens to patient at stage 2
75-90% loss Polyuria Nocturia Hyponatremia Increase in BUN May be diet controlled
Stage 3, what to do?
Same as #2
Stage 4 what to do?
Initiate AV fistula
RRT is considered for
Fluid overload
Really bad hyperkalemia
Symptoms from azotemia
Stage 5, what to do ?
More than 90% loss
Hyperkalemia kills them
Death without transplant or RRT
CKD manifestations
Kidney changes
Metabolic changes
Electrolyte changes
Calcium can not be
Absorbed from food due to decrease production of vitamin D, also stimulated by kidneys
Calcium is reabsorbed from the bones to
Balance the loss in the blood and pH of blood
Also need for muscle contraction
Phosphate binders
Eat with food to decrease phosphorus
Keeps calcium up and bones in better shape
Calcium and blood
Calcium is needed for clotting cascade
Uremia manifestations
Metallic taste in mouth Anorexia Nausea Vomiting Muscle cramps Uremic frost Itching Fatigue Hiccups Edema Dyspnea Paresthesias
Creatinine
Comes from proteins in skeletal muscle
BUN levels
Vary with protein intake
Renal osteodystrophy
Less vitamin D from kidney= less calcium
Increased phosphorus
Increased parathyroid hormone
Bone mineral loss
Pericarditis
Occurs with CKD
Pericardial sac becomes inflamed from toxins
Decreased erythropoietin levels
Decreased RBC lifespan
Decreased platelets
Calcium channel blockers best for
Improve GFR
ACE inhibitors best for
Slow progression of pts with CKD and hypertension
