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
one of most important goals with CKD
blood pressure control (usually hypertensive)
most effective treatment of hyperkalemia
dialysis
med that can be given to treat hyperkalemia with CKD
kayexalate
3 meds that can be given to treat anemia with CKD
epoetin alfa
darbepoeitin alfa
iron
contraindications for kidney transplant (6)
- advanced cancer
- untreated heart disease
- chronic respiratory failure
- extensive vascular disease
- chronic infection
- unresolved psychosocial disorders
3 types kidney transplant rejection
hyperacute
acute
chronic
type of kidney transplant rejection:
- minutes to hours after
- antibody-mediated
- remove transplanted organ
hyperacute
type of kidney transplant rejection:
- days to months after
- can be reversible
acute
type of kidney transplant rejection:
- months to years
- irreversible
chronic
• Movement of fluid/molecules across a semipermeable membrane from one
compartment to another
• Used to correct fluid and electrolyte imbalances and removes waste products in
kidney failure
dialysis
two methods of dialysis
peritoneal dialysis (PD) hemodialysis (HD)
when should a patient be started on dialysis
GFR <15
• Water and fluid removal
• Results when there is an osmotic gradient or pressure gradient across membrane
-moves extra fluid into dialysate
ultrafiltration
what causes ultrafiltration in peritoneal dialysis
glucose in dialysate
what causes ultrafiltration in hemodialysis
pressure gradient
three stages of peritoneal dialysis
fill
dwell
drain
osmotic agent in peritoneal dialysis
dextrose
S+S of peritonitis during PD (5)
- abdominal pain
- fever
- N/V
- distention
- increased bowel sounds
two types of access in hemodialysis
AV fistulas and grafts
temporary vascular access
how long is the AV access site created before it is needed for hemodialysis
3 months
what should you hear/feel when assessing AV fistula/graft during hemodialysis
thrill
bruit
how often should you monitor VS during hemodialysis
30-60 mins
4 complications with hemodialysis
- hypotension
- muscle cramps
- loss of blood
- hepatitis
