Kidney Crap

Question 1

What do the kidneys do?

What is their normal function?

Answer 1

Removal of sodium
Removal of water // Retaining water
Removal of waste
- Urea and Creatinine
Hormone production
- Erythropoietin and Vitamin D

Question 2

What is urea?

Answer 2

Bi-product of protein breakdown

Question 3

What is creatinine?

Answer 3

Bi-product of muscle breakdown

Question 4

What does RAAS stand for?

Answer 4

Renin
Angiotensin
Aldosterone
System

Question 5

What is the purpose of renin in RAAS?

Answer 5

Converts angiotensin 1 into angiotensin 2

Question 6

What is the purpose of aldosterone in RAAS?

Answer 6

Allows for reabsorption of sodium and water

Question 7

What diet should kidney patients avoid?

Answer 7

Ketogenic

Question 8

What does GFR stand for?

Answer 8

Glomerular
Filtration
Rate

Question 9

What is the normal value for GFR?

Answer 9

125 mL/min

Question 10

The kidneys remove “waste”. What is included in the “waste”?

Answer 10

Creatinine, urea, potassium and other electrolytes

Question 11

Too much potassium can cause what major problem?

Answer 11

Stop the heart

Question 12

Too little potassium can do what?

Answer 12

Cause dysrythmias

Question 13

What is epogen?

Answer 13

A medication given to increase RBC production

Question 14

What do “normal” kidneys do with bicarb that kidneys that are failing cannot do?

Answer 14

Normal kidneys are able to reabsorb bicarb and excrete it. Failing kidneys cannot.

Question 15

What is normal creatinine?

Answer 15

1 (Best for kidney function)

Question 16

What is normal BUN?

Answer 16

20

Question 17

Does a patient with a HIGH BUN but a normal creatinine indicate kidney failure?

Answer 17

No. It could mean the patient is dehydrated. 
Both values (BUN and creatinine ) should be affected to indicate kidney damage.

Question 18

What causes prerenal failure?

Answer 18

A sudden decreased blood flow to the kidneys or decrease in B/P

Examples:
Excessive blood loss (hemorrhage), shock

Question 19

What causes intrarenal failure?

Answer 19

Cause affects ACTUAL kidney

Examples:
Inflammation, toxins, drugs, infection, nephrotoxic meds

Question 20

What causes postrenal failure?

Answer 20

Obstructions

Examples:
Tumor, clot, BPH, stones

Question 21

How much output would a pt in oliguria be putting out?

Answer 21

< 400 mL/day

Question 22

How does a pt present (s/s) in the oliguria phase?

Answer 22

Edema in extremities
- Excess fluid moves to lungs, then to heart
Increased B/P
Trouble breathing
- Crackles (due to fluid build up)
Metabolic Acidosis

Question 23

How much output would a pt in nonoliguric be putting out?

Answer 23

> 400 mL/day

NOTE:
Even though they are still putting out a lot, they aren’t ridding the body of waste

Question 24

How much does a pt put out in the diuretic phase?

Answer 24

Up to 5 L/day

What must we check?
- B/P

Question 25

How long does kidney recovery take?

Answer 25

Up to a year Sometimes pt's don't get better

Question 26

Which classification of kidney failure is reversible?

Answer 26

Acute

Question 27

Clinical manifestations of ACUTE renal failure

Answer 27

``` N/V/D Lethargy Dehydration Dark, concentrated urine - "Casts" in urine (tubules slothing off) Headache ```

Question 28

What leads to chronic renal failure?

Answer 28

Unresolved ACUTE renal failure

Question 29

Clinical manifestations of CHRONIC renal failure

Answer 29

Increased B/P Dysrhythmias Anemia - decrease in RBC, increase in HR Confusion Major complication: heart failure

Question 30

How quickly do kidneys lose function in ARF?

Answer 30

A matter of hours or days

Question 31

Chronic Kidney Disease: | Stage 1 of 5

Answer 31

Kidney damage (protein in urine) and normal GFR GFR - More than 90 Kidney function deterioration - 50-60%

Question 32

CKD: | Stage 2 of 5

Answer 32

Kidney damage and mild decrease in GFR GFR - 60-88 Kidney function deterioration - 60-70%

Question 33

CKD: | Stage 3 of 5

Answer 33

Moderate decrease in GFR GFR - 30-59 Kidney function deterioration - 70-77.5%

Question 34

CKD: | Stage 4 of 5

Answer 34

Severe decrease in GFR GFR - 15-29 Kidney function deterioration - 77.5-85%

Question 35

CKD: | Stage 5 of 5

Answer 35

Kidney failure - End stage - Dialysis or kidney transplant is needed GFR - < 15 Kidney function deterioration - 85% and above

Question 36

Hemodialysis

Answer 36

Traditional form of dialysis PC's: - Hypovolemia - Loss of blood, leading to anemia

Question 37

Peritoneal Dialysis

Answer 37

Dialysis through the stomach PC's: Loss of more protein than traditional dialysis

Question 38

Where doe ACE inhibitors work?

Answer 38

In the kidneys, not the heart

Question 39

What do ACE inhibitors do?

Answer 39

Stop the conversion of angiotensin 1 from converting into angiotensin 2 - causing vasodilation - helping to lower the blood pressure

Question 40

What medications should a dialysis patient avoid before dialysis and why?

Answer 40

Blood pressure and related medications Why? The patient will be at a higher risk for hypovolemia. Hypovolemia causes hypotension due to fluid loss. If the patient were to take their b/p med and become hypovolemic during dialysis, it could be highly dangerous for them.

Question 41

How is a patient's blood pressure if they suffer from kidney failure?

Answer 41

HIGH Why? Due to a buildup of fluid that the kidneys are unable to rid the body of, thus causing heart problems

Question 42

Say a patient with kidney failure has trauma causing them to bleed out... Will the RAAS system kick in to increase the B/P to help compensate for the blood loss?

Answer 42

NO! The RAAS system is unavailable when a patient is in kidney failure

Question 43

How does osmosis work in dialysis?

Answer 43

Glucose (dextrose) is added to the dialysate solution and is causes an osmotic gradient across the membrane, pulling the excess fluids from the blood.

Question 44

How does diffusion work in dialysis?

Answer 44

The movement of solutes (creatinine, uric acid, electrolytes) from the blood to the dialysate. Purpose is to lower blood concentration.

Question 45

What is the recovery phase?

Answer 45

GFR begins to increase allowing BUN and creatinine to decrease. Usually happens for 1-2 weeks. Urine will be concentrated.

Question 46

What is the diuretic phase?

Answer 46

In this phase, kidneys have recovered their ability to excrete waste, however they still cannot concentrate the urine. Usually lasts 1-3 weeks

Question 47

What is azotemia?

Answer 47

The accumulation of nitrogenous waste products in the blood

Question 48

Normal ranges for potassium

Answer 48

3.5 - 5