KIDNEYS Flashcards
Emergent dialysis requirements
Elevated Potassium
Metabolic acidosis
Hypovolemia
Glomerulonephritis
Children, over 60
Chronic
atuoimmune, genetic, or drug use
Nephritic syndrome
Inflammation of glomeruli HTN Hematuria Oliguria Berger's disease (most common cause)
Neprhotic syndrome
Hypoalbuminemia-> albumin excreted, reduction in oncotic pressure-> edema
Hyperlipidemia
Mega proteinuria
Nephrosclerosis
Benign: over 60, Vasc. changes w/ htn/atherosclerosis
Malignant: significant HTN, malignant HTN
Renal Artery Stenosis
Atherosclerosis of renal arteriies
Can be one or both branches
Cause of secondary HTN
Renal Vein Thrombosis:
Basically a DVT in kidneys
Polycystic Kidney Disease (PKD)
4th cause of ESRD
Genetic
Manifestations: Ruptured cysts, HTN, pain/heaviness
May need nephrectomy
Kidney Cancer
Renal cell carcinoma
Male
Smoker
Obese
Family Hx
AKI Acute Kidney Injury
Oliguric Phase
Diuretic Phase
Recovery phase
Oliguric phase (AKI)
Phase 1 of AKI
Oliguria- <400mL/day within 1-7 days of kidney injury
Urinalysis (specific gravity fixated at 1.010)
Metabolic acidosis
Hyperkalemia, Hyponatremia
Elevated BUN and Creatinine
Fatigue, malaise
Diuretic phase (AKI)
Phase 2 of AKI
Gradual inc. in urine output
Hypovolemia, dehydration
Hypotension
BUN and Creatinine normalizes
Recover phase (AKI)
Phase 3 of AKI
GFR increases
BUN and creatinine plateaus and then drops
Risk factors for AKI
Pre-existing kidney disease MODS/sepsis Age Trauma Surgery Burns
Rifle classification of AKI
R: RISK
I: INJURY
F: FAILURE
L: LOSS
E: ESKD
RIFLE (R)
Risk
Serum creatinine 1.5x baseline OR GFR decrease by 25%
Urinary output under .5mL/kg/hr for 6hr
RIFLE (I)
Injury
Creatinine 2x baseline
GFR decreases by 50%
Urinary output:
RIFLE (F)`
Failure
3x baseline serum creatinine
GFR decreases 75%
Or Creatinine aboce 354 umol/L with acute rise of 44umol/L
Urinary output >.3mL/kg/hr for 24hr
or Anuria for 12 hr
RIFLE (L)
Loss
Persistent acute renal failure= complete loss of kidney function for more than 4 weeks
RIFLE (E)
End Stage Kidney Disease for more than 3 months
Pre-renal issue causes
Hypoperufsion: Volume depletion, vascular issues, shock
Decreased filtration (Hypotension): most common in Peds
Cardiac Output: MI, HF
Intrinsic renal issue causes
Glomerular: Acute glomerulonephritis
Vascular: Vasculitis, Atheroemboli, manipulation of aorta
Tubulointerstitial: Acute tubular necrosis
MEDS that can cause pre-renal injury
Ace inhibitors
ARB (Angiotensin II blockers)
NSAIDS
COX-2 inhibitors (celecoxib)
Loop diuretics, thiazide diuretics
Immunomodulators: Cyclosporine
MEDS that can cause ATN (Acute Tubular Necrosis)
Antibiotics
HIV meds
Statin (lovastatin): rhabdomyolysis
Biphosphonates
Post Renal issue causes
10% of renal issues
Obstructions: Prostate Intraperitoneal tumor Stones Trauma
AKI nursing considerations
Volume status: watch for excess urine and edema, look for osmolality
Review labs: GFR, creatinine
Flank pain, muscle pain
Infection/sepsis
Cardiac: BP/EKG
Respiratory compensation
Nursing considerations for Phase 1 AKI (Oliguric)
Manage Fluid volume Sodium balance Acid/base balance Hyperkalemia Hematologic considerations (hypovolemia, hypoalbuminemia etc.)
Watch for waste accumulation
Neurologic disorders
Nursing considerations for Phase 2 AKI (Diuretic)
High urine volume means watch volume management and electrolytes
Nursing considerations for Phase 3 AKI (Recovery)
Look for GFR increases
Let them know it may take up to a year to heal fully
Differences between AKI and CKD
Acute can turn into chronic
Chronic: Better tolerates wide lab ranges Anemia, cachexia, gray skin Low calcium Stable (out of range) creatinine
Chronic normocytic anemia
Renal Ultrasound: Scars/large kidneys
Acute:
Hypotension, fluid overload, metabolic acidosis
Rapid increasing creatinine
Normal calcium
Renal ultrasound normal
End Stage Renal Disease
Under 15mL/min GFR
Inc BP Pitting edema HF Pulmonary Edema Ammonia odor to breath Anorexia Anemia
Yellow/gray skin
Metabolic acidosis
Inc. potassium
Chronic Renal failure stage 1 GFR
Kidney damage w/normal function
90+
Chronic Renal failure stage 2GFR
Kidney damage w/mild loss function
89-60
Chronic Renal failure stage 3A GFR
Mild to moderate loss of kidney function
59-44
Chronic Renal failure stage 3b GFR
Moderate to severe kidney function loss
44-30
Chronic Renal failure stage 4 GFR
Severe loss kidney function
29-15
Chronic Renal failure stage 5 GFR
Kidney failure
under 15
Nursing considerations for CKD
Dietary restrictions: High fat, low protein, low sodium, low potassium, low phosphorus. Fluid restrictions
Ostrosdystrophy: Give calcium/phosphorus balance-binders, PTH, Vit D
Anemia: ESA (erythropoeitin stimiulating agents), Iron, blood
Pediatric considerations for CKD
Impeded physical growth/sexual maturation
Developmental issues
Who needs dialysis (AEIOU)
Acid-base problems Electrolyte problems Intoxications Overload of fluids Uremic symptoms
Renal replacement therapies for ESRD
palliative care
Transplant
Hemodialysis
Peritoneal dialysis
Peritoneal dialysis
CAPD 3-5 times/day
20-40 min at a time
CCPD done overnight
Catheter in abdomen STERILE TECHNIQUE
Diffusion dependent on time, volume, speed of transport
Osmotic gradient determined by dextrose solution % used
Adequacy measured by KT/V
Residual renal function lasts longer in PD
Hemodialysis considerations
Fluid, sodium, potassium, phosphorus restricted
Encourage more protein (can be filtered now)
Phosphorous binders
Watch access management
Assess for thrills/bruits
NO BP, IV, NEEDLE STICKS on access limp
DON’T USE DIALYSIS CATH FOR GENERAL USE- only EMERGENCY
Take weights daily
Watch fluid management, I&Os
Creatinine range
.8-1.2mg/dL
BUN range
7-20mg/dL
