Kidney Disorders Flashcards
anuria
less than 50 ml UOP in 24 hours
oliguria
less than 400 ml UOP in 24 hours
what is normal GFR
> 60 mL per minute
what is normal BUN
6-24 mg/dL
what is normal creatinine
0.7-1.3 mg/dL
azotemia
abnormally concentrated nitrogen waste in the blood
urinary casts
proteins secreted from damaged kidney tubules
what substances are normally filtered by the kidneys?
electrolytes - sodium, chloride, potassium, calcium, bicarbonate, magnesium, phosphorous
waste products - urea, creatinine, uric acid
glucose
manifestations of fluid deficit
weight loss
decreased skin turgor
dry membranes
oliguria
increased hematocrit and BUN
manifestations of potassium deficit
anorexia
paralytic ileus
EKG changes
dysrhythmias
manifestations of potassium excess
diarrhea
nausea
irritability
EKG changes
weakness
manifestations of hyponatremia
nausea
malaise
lethargy
headache
seizures
manifestations of hypernatremia
dry mucous membranes
thirst
dry tongue
fever
disorientation
what is glomerulonephritis?
inflammation from antibody complexes being deposited in glomeruli
what can cause glomerulonephritis?
GAS
viral infections
autoimmunity
what is the other name for glomerulonephritis?
acute nephritic syndrome
manifestations of glomerulonephritis
azotemia - high nitrogen waste in blood
hematuria, proteinuria, cola colored urine
oliguria
edema, HTN, flank pain, headache, malaise
lab findings for glomerulonephritis
elevated BUN and creatinine
hypoalbuminemia
hyperlipidemia
complications of glomerulonephritis (think fluid excess)
hypertensive encephalopathy
heart failure
pulmonary edema
management of glomerulonephritis
corticosteroids
hypertension management
antibiotics if caused by infection
protein restriction
sodium restriction
strict I/O, daily weight
what is chronic glomerulonephritis?
repeated episodes of acute nephritic syndrome causes kidneys to shrink and develop scar tissue
can progress to stage 5 CKD
symptoms of chronic glomerulonephritis
weight loss
fatigue
irritability
headache, dizziness
GI disturbances
treatment of chronic glomerulonephritis
dialysis
treat fluid and electrolyte imbalances
what is nephrotic syndrome?
glomeruli become more permeable
massive proteinuria
manifestations of nephrotic syndrome
hypoalbuminemia -> generalized edema
hyperlipidemia
complications of nephrotic syndrome
infection
thromboembolism
AKI
atherosclerosis
what is the cause of polycystic kidney disease?
90% of cases are caused by autosomal dominant genetic trait
what is PKD?
fluid filled cysts on the kidneys that cause them to enlarge
this is the most common cause of kidney failure
manifestations of PKD
abdominal fullness and flank pain
hematuria
polyuria
hypertension
renal calculi
UTIs
proteinuria
diagnosing PKD
family history
ultrasound
palpation
PKD treatment
BP control
pain control
dialysis
kidney transplant
mortality rate of AKI
40-90%
what is prerenal AKI?
occurs due to hypoperfusion
caused by decreased CO, hypotension, hypovolemia
what is infrarenal AKI?
occurs due to damage of glomeruli or tubules
can cause acute tubular necrosis
what is postrenal AKI?
occurs due to urinary obstruction
what is the most common category of causes of AKI?
prerenal - hypoperfusion
what are the four phases of AKI?
initiation
oliguria
diuresis
recovery
lab findings for AKI
elevated BUN and creatinine
decreased GFR
elevated potassium and phosphorus
metabolic acidosis
manifestations of AKI
dry mucous membranes
anemia
SOB, edema
managing AKI
fluid balance:
daily weight
I/Os
IVF and blood products
diuretics
preventing AKI
limit use of contrast agents
take care when using nephrotoxic meds
hydration
shock management
monitor output
assess BUN and creatinine
prevent UTI
what causes CKD?
diabetes - #1 cause
hypertension - #2 cause
prolonged inflammation
and kidney condition - infections, PKD, kidney stones
what is normal GFR?
125 mL per minute
how are stages of kidney disease defined?
percent of normal function
stage 1 - 90% function
stage 2 - >60% function
stage 3 - >30% function
stage 4 - >15% function
stage 5 - <15% function
clinical manifestations of CKD
anemia
metabolic acidosis
hyperkalemia
sodium and water retention, HTN
calacium and phosphorus imbalance - bone disease
decreased GFR
increased BUN and creatinine
CKD treatment
control BP and hyperglycemia
treat anemia
smoking cessation
weight loss
decrease sodium, alcohol, nephrotoxic meds
hydration
medications for CKD
calcium supplement and phosphate binder
antihypertensives
diuretics
erythropoietin
renal diet
restriction on protein, sodium, potassium, phosphorus
vitamin supplement
fluid restriction
hematologic manifestations of ESRD
anemia, thrombocytopenia
integumentary manifestations of ESRD
thin hair and dry flaky skin
cardio manifestations of ESRD
HTN, hyperkalemia, hyperlipidemia
pulmonary manifestations of ESRD
crackles, SOB, tachypnea
musculoskeletal manifestations of ESRD
bone fractures, muscle cramps, loss of muscle strength
GI manifestations of ESRD
anorexia, ammonia odor
schedule for long term dialysis
3 days per week - every other day
takes 3-5 hours per session
what is the goal of dialysis?
remove toxic nitrogen waste
remove excess fluid
correct electrolyte balance
what is dialysate?
solution that circulates through dialyzer to remove fluids, balance electrolytes, correct acidosis
how does AV fistula work?
surgically joins artery and vein in forearm
must mature 2-3 months before use
two large-bore IVs are inserted during dialysis
what is an AV graft?
synthetic graft used to connect artery and vein for hemodialysis
what is a hemodialysis catheter?
inserted into subclavian or jugular vein for hemodialysis
complications of hemodialysis
anemia
SOB between treatments
hypotension
NV
muscle cramping
blood loss
air embolism
dysrhythmias
chest pain
neuro - decreased LOC, seizure
what is peritoneal dialysis?
dialysate inserted into abdomen with catheter, then drained
diffusion and osmosis occurs through the semi permeable peritoneal membrane
what should dialysate look like when it is drained out of the abdomen?
clear - cloudy is bad
what kind of procedure is peritoneal dialysis?
sterile procedure
what is continuous ambulatory peritoneal diaalysis?
dialysate is infused 4-5 times a day, drained after 4-5 hours = 24/7 dialysate
what is continuous cyclic peritoneal dialysis?
machine provides fluid exchange during sleep
extended dwell time of dialysate during the day, no daytime exchanges
acute complications of peritoneal dialysis
peritonitis
leakage
bleeding
what does it mean if dialysate drainage is cloudy?
peritonitis
signs and symptoms of peritonitis
abdominal pain
hypotension
shock
how is peritonitis treated?
intraperitoneal antibiotics
what are long-term complications of peritoneal dialysis?
abdominal hernias
low back pain
anorexia
clots in catheter
CV disease
what consideration should be taken with BP meds and hemodialysis?
hypotension common during hemodialysis, so BP meds should be held prior
