Kidney Failure Flashcards
Obstruction of Urine Flow ●calculi ●enlarged prostate (BPH) ●tumors ●strictures ●blood Clots
Post renal causes
Direct trauma ATN /structural damage to kidney ◦trauma, Lupus, HTN •nephrotoxic drug therapy** •infections (glomerulonephritis, pyelonephritis) •burns - myoglobinuria •transfusion reaction - hemoglobinuria • exposure to heavy metals, chemicals, pesticides, solvents
Inter-renal trauma
hypovolemia ◦hemorrhage; v/n/d; diuretics; volume shifts •↓ cardiac output: ◦MI; CHF; shock (Septic shock) •anaphylaxis •vascular obstruction Hypofusion/ interference of kidneys
Pre-renal causes
- increased urea in blood
◦uremia – symptomatic , bl levels ↑ creat/ BUN
azotemia
Initiation Period
•Oliguria*
•Diuresis*
•Recovery
Phases of acute renal failure
- the beginning- initial damage
- ischemia or damage to kidney
- functional loss of 75% nephrons
Incubation period of ARF
- 10 days – 4 weeks
- urine less than 400ml/24h
- uremic symptoms appear- drowsy, headache
- rise in urea; uric acid; creatinine; magnesium; potassium;
- fluid volume overload
- metabolic acidosis
- hyperkalemia - life threatening
- the longer the phase, the poorer the prognosis
Oliguric phase ARF
- 1 – 3 weeks
- gradual increase in urine output
- lab values begin to descend
- monitor for dehydration
- output greater than 2000 cc/day
- I&O essential
Diuresis phase ARF
- renal function improves
- may take 3 - 12 months
- GFR increase
- lab values return to normal
- 1 - 3 % permanent loss in GFR
Recovery phase ARF
•urinalysis: protein, casts •24 h Urine: decreased GFR •serum chemistries: ◦↑ potassium, phosphate, BUN / creatinine ◦↓ Ca, CO2 •CT/MRI •ABG: metabolic ac
Diagnostic findings of ARF
◦Urinary - oliguria ◦Cardiovascular •fluid overload, HTN ◦Respiratory •pulmonary edema / Kussmauls ◦Neuro •lethargy/drowsiness •headache/ muscle twitching •seizures ◦GI •n/v/d
Clinical manifestations of ARF
3.5-5.0 mEq/L
Hyperkalemia
◦dyspnea ◦Oliguria ◦cardiac arrhythmias •peaked T waves •bradycardia , irregular pulse, v-fib •needs monitoring ◦n/d ◦intestinal cramps – smooth muscle hyperactivity ◦neuromuscular irritability/weakness ◦flaccid paralysis
Hyperkalemia
chocolate
•dried fruit, nuts and seeds
•oranges, bananas, apricots and cantaloupe
•meat
•beans, potatoes, tomatoes, celery and mushrooms
Dietary sources of potassium
dialysis •fluid restriction (output + 500 cc) •daily weight •Dietary restrictions: o low protein- (40-80 g/day) o low potassium- (40mEq/day) o low Na- (2000mg/day) o low phos/Ca- (500-600mg/day) ●No restriction for CHO- unlimited sugars
Medical management of ARF
◦po or rectal enema • monitor Na and K+ •restrict Na/K+ foods •retain enema 30-60 “ •may cause constipation ◦IV Rx for hyperkalemia •Calcium gluconate •Sodium Bicarb •Insulin/Glucose
Sodium polystyrene sulfonate
Hypofusion of kidney
Increased BUN/creatinine
Decreased urine output
Urine sodium
Pre-renal
Parenchymal damage Increased BUN/Creatinine Decreased urine output Ursine sodium > 40 mEq/L Abnormal cast and debris Specific gravity may be normal/low
Intrarenal
Obstruction
Increased BUN/Creatinine
Urine output may be diminished or Anuria
Normal urinary sediment
Post renal
● normal range- 1.010- 1.025
Urine Specific Gravity
Norm 0.6-1.2 mg
Creatinine
Radiocontrast material •Cyclosporine* •Aminoglycosides •Chemotherapy •Heavy metals- gold •NSAID/ASA •ACE Inhibitors •*cyclosporin -gold standard for transplant patients
Nephrotoxic drugs
Stenosis
Infection
Thrombosis
Complications of AV graft
Deposits on the skin can occur causing itching
Phosphorus deposits
