Kidney Failure

Question 1

What are the functions of the urinary system (kidneys)

Answer 1

Regulate volume of extracellular fluid
  Regulate composition of extracellular fluid
  Excrete waste products
  Produce erythropoetin
  Activate Vitamin D
  Help regulate blood pressure

Question 2

How much and what are we reabsorbing in the proximal tubules

Answer 2

80% of electrolytes

100% of glucose and amino acids

Question 3

What waste products are in the proximal tubules

Answer 3

creatinine and hydrogen ions

Question 4

What drugs work on the loop of henle

Answer 4

loop diuretics like lasix

Question 5

What is pulled out of the loop of henle

Answer 5

H2o
Na+
Cl-

Question 6

What is normal creatinine clearance

Answer 6

(140 - age)(Kg)/(72 X Pcr)

Question 7

If the PTH has been trigger

Answer 7

calcium is low

Question 8

If ANP is triggered then

Answer 8

blood pressure is too high

Question 9

If ADH is triggered then

Answer 9

blood pressure is too low

Question 10

If we have acidosis then

Answer 10

we bind H+ with Nitrogen so we’ll produce ammonia

Question 11

If pH is normal then

Answer 11

bicarbonate will be 100% reabsorbed

Question 12

What are some assessments for kidney failure

Answer 12

CVangle
suprapubic pain
anemia

Question 13

What is the major cause of death with acute kidney failure

Answer 13

infection

Question 14

What is a rec for proactive care for ARF

Answer 14

get vaccinated

Question 15

What are some causes of ARF

Answer 15

Severe, prolonged hypertension (↓ perfusion)
Hypovolemia (↓ Cardiac output and ↓ perfusion)
Acute Tubular Necrosis – (differentiated by casts in urine)
Nephrotoxic
Trauma

Question 16

What elevates within hours in ARF with or without what

Answer 16

BUN
creatinine
potassium
with or without oliguria

Question 17

What are the risk factors of ARF

Answer 17

InsulinDependentDiabetesMellitus or Non-IDDM – 40% risk
Hypertension
Hypovolemia
Prolonged exposure to drugs excreted by kidney
Tylenol
Nephrotoxic drugs

Question 18

What are some nephrotoxic drugs

Answer 18

ACE inhibitors
Aminoglycosides
Cephalosporins
Sulfonamides
Tetracycline
Vancomycin
Immunosuppressants

Question 19

What is the problem with prerenal

Answer 19

perfusion

Question 20

Is prerenal and post renal problems reversible

Answer 20

usually

Question 21

If its damage is from prerenal then what wounld the UA show

Answer 21

low sodium

high specific gravity

Question 22

What UA would you see in intrarenal damage

Answer 22

high sodium
casts
WBC and RBC
specific gravity of 1.010

Question 23

What is after the oliguric phase

Answer 23

diuretic phase 1-3 wks

Question 24

How many liters will the person start producing in the diuretic phase

Answer 24

1-4 L

Question 25

What will happen to creatinine and BUN levels in diuretic phase

Answer 25

low creatinine clearance

high serum BUN and Creatinine

Question 26

How long does the recovery phase last

Answer 26

12months

Question 27

What are acid and protein problems with ARF

Answer 27

metabolic acidosis and increased BUN levels in blood

Question 28

What are some precautions for a 24 hr urine analysis

Answer 28

No toilet paper in specimen
Defecate prior to voiding
Adequate fluid intake
Avoid vigorous exercise

Question 29

What are the collaborative problems we target with ARF

Answer 29

CO
fluid overload
infection
potassium overload

Question 30

How do we treat hyperkalemia

Answer 30

kayexalate

dialysis

Question 31

What are the indications for dialysis for ARF

Answer 31

↑ Fluid volume overload to the point of (respiratory compromise)

(2) ↑ Potassium with EKG changes
(3) Metabolic acidosis from ↓bicarb (< 15)

Question 32

What are the nutrition restrictions for ARF

Answer 32

restrict potassium and protein 
get cals from fat 
regulate fluid volume
vit D supplement
high CHO
calcium supplement
phosphate binders like TUMS with meals

Question 33

What cause class would sepsis or anaphylaxis

Answer 33

pre-renal