Kidney Failure Flashcards
What are the functions of the urinary system (kidneys)
Regulate volume of extracellular fluid Regulate composition of extracellular fluid Excrete waste products Produce erythropoetin Activate Vitamin D Help regulate blood pressure
How much and what are we reabsorbing in the proximal tubules
80% of electrolytes
100% of glucose and amino acids
What waste products are in the proximal tubules
creatinine and hydrogen ions
What drugs work on the loop of henle
loop diuretics like lasix
What is pulled out of the loop of henle
H2o
Na+
Cl-
What is normal creatinine clearance
(140 - age)(Kg)/(72 X Pcr)
If the PTH has been trigger
calcium is low
If ANP is triggered then
blood pressure is too high
If ADH is triggered then
blood pressure is too low
If we have acidosis then
we bind H+ with Nitrogen so we’ll produce ammonia
If pH is normal then
bicarbonate will be 100% reabsorbed
What are some assessments for kidney failure
CVangle
suprapubic pain
anemia
What is the major cause of death with acute kidney failure
infection
What is a rec for proactive care for ARF
get vaccinated
What are some causes of ARF
Severe, prolonged hypertension (↓ perfusion)
Hypovolemia (↓ Cardiac output and ↓ perfusion)
Acute Tubular Necrosis – (differentiated by casts in urine)
Nephrotoxic
Trauma
What elevates within hours in ARF with or without what
BUN
creatinine
potassium
with or without oliguria
What are the risk factors of ARF
InsulinDependentDiabetesMellitus or Non-IDDM – 40% risk
Hypertension
Hypovolemia
Prolonged exposure to drugs excreted by kidney
Tylenol
Nephrotoxic drugs
What are some nephrotoxic drugs
ACE inhibitors Aminoglycosides Cephalosporins Sulfonamides Tetracycline Vancomycin Immunosuppressants
What is the problem with prerenal
perfusion
Is prerenal and post renal problems reversible
usually
If its damage is from prerenal then what wounld the UA show
low sodium
high specific gravity
What UA would you see in intrarenal damage
high sodium
casts
WBC and RBC
specific gravity of 1.010
What is after the oliguric phase
diuretic phase 1-3 wks
How many liters will the person start producing in the diuretic phase
1-4 L
What will happen to creatinine and BUN levels in diuretic phase
low creatinine clearance
high serum BUN and Creatinine
How long does the recovery phase last
12months
What are acid and protein problems with ARF
metabolic acidosis and increased BUN levels in blood
What are some precautions for a 24 hr urine analysis
No toilet paper in specimen
Defecate prior to voiding
Adequate fluid intake
Avoid vigorous exercise
What are the collaborative problems we target with ARF
CO
fluid overload
infection
potassium overload
How do we treat hyperkalemia
kayexalate
dialysis
What are the indications for dialysis for ARF
↑ Fluid volume overload to the point of (respiratory compromise)
(2) ↑ Potassium with EKG changes
(3) Metabolic acidosis from ↓bicarb (< 15)
What are the nutrition restrictions for ARF
restrict potassium and protein get cals from fat regulate fluid volume vit D supplement high CHO calcium supplement phosphate binders like TUMS with meals
What cause class would sepsis or anaphylaxis
pre-renal
