lewis ch 46 (AKI, CKD, kidney transplant, dialysis) Flashcards
descriptors of acute kidney injury (5 - onset, caused by, classified by, (non)reversible, cause of death)
- sudden
- caused by acute tubular necrosis
- classified by acute reduction in urine output and/or elevated serum creatinine
- potentially reversible
- cause of death: infection
descriptors of chronic kidney disease (5- onset, caused by, classified by, (non)reversible, cause of death)
- gradual onset over years
- caused by diabetic neuropathy
- classified by GFR<60 for >3 months and/or kidney damage >3 months
- progressive and irreversible
- cause of death: cardiovascular disease
S+S acute kidney injury (4)
- rapid loss of kidney function
- rise in serum creatinine and/or reduced urine output
- elevated BUN and potassium
- azotemia (accumulation of waste products)
5 causes acute kidney injury
- recent infection
- certain meds
- severe dehydration
- exposure to heavy metals or toxic solvents
- blood loss, shock
type of acute kidney injury:
sudden and severe drop in bp or interruption of blood flow to kidneys from severe injury or illness
prerenal
type of acute kidney injury:
direct damage to kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
intrarenal
type of acute kidney injury:
sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury
postrenal
three phases of acute kidney injury
oliguric
diuretic
recovery
rifle classification for acute kidney injury
R: risk I: injury F: failure L: loss E: end-stage renal disease
classifications for oliguric phase of acute kidney injury (3)(related to urinary system)
- urine output <400 mL/day
- urinalysis: RBC, WBC, casts, protein
- specific urine gravity: 1.010
during oliguric phase of AKI, decreased urine output causes fluid retention which is evidenced by (4)
hypertension
JVD
edema
bounding pulse
manifestations of oliguric phase of acute kidney injury (other body systems) (6)
- metabolic acidosis
- hyponatremia
- hyperkalemia
- leukocytosis
- increased BUN and creatinine levels
- fatigue, seizures, coma
classifications of diuretic phase of acute kidney injury (4) (relating to urinary system)
- daily urine output between 1-5 L
- increased GFR
- decreased BUN and creatinine
- dehydration and hypovolemia
classifications of recovery phase of acute kidney injury (3)
- GFR increases
- BUN and creatinine levels plateau then drop
- lasts up to 12 months
diagnostic studies for acute kidney injuries (5)
- labs: creatinine, BUN, electrolytes
- urinalysis
- ultrasound
- CT
- renal biopsy
meds for AKI
- loop diuretic
- osmotic diuretic
example of loop diuretic med
furosemide
example of osmotic diuretic med
mannitol
dietary changes for treatment of AKIs
- restrict sodium, potassium, and phosphate
- adequate protein
- adequate carbs and increased fat
- calcium supplements
in what populations is chronic kidney disease more commonly seen (4)
- older adults
- obesity
- diabetes
- hypertension
2 defining factors of CKD
- kidney damage
- low GFR (<60 mL/min for more than 3 months)
stages of CKD
1, 2, 3a, 3b, 4, 5
S+S end stage renal disease (7)
- edema
- high bp
- ammonia breath odor
- anemia
- increased potassium
- dry, itchy, yellow tinted skin
- bone pain and muscle cramps
most serious electrolyte disorder in kidney disease
hyperkalemia
