Management of Patients with Kidney Disorders Flashcards
Acute kidney injury
rapid loss of renal function due to damage to the kidneys
What is the greatest indicator of kidney damage in AKI?
50% or greater increase in serum creatinine above baseline
Causes of AKI
Hypovolemia
Hypotension
Reduced cardiac output
Heart failure
Obstruction of kidney or lower urinary tract
Obstruction of renal arteries or veins
Nephrotoxic agents
3 Categories of an Acute Kidney Injury
Prerenal
Intrarenal
Postrenal
4 Phases of an Acute Kidney Injury
Initiation
Oliguria
Diuresis
Recovery
Prerenal AKIs are often due to what?
Hypoperfusion from shock
Intrarenal AKIs are often due to what?
Nephrotoxic drugs or agents
Postrenal AKIs are often due to what?
Stone or tumor
How long can recovery take in an acute AKI?
up to 12 months
Chronic kidney disease
umbrella term that describes kidney damage or a decrease in the GFD lasting for 3 months or more
Untreated CKD leads to what?
ESKD
Causes of chronic kidney disease
DM
HTN
Chronic glomerulonephritis
Pyelonephritis
Hereditary lesions
Vascular disorders
Medications or toxic agents
What is nephrosclerosis?
Hardening of renal arteries
What is the main cause of CKD?
DM
What is the second main cause of CKD?
HTN
2 types of nephrosclerosis
Acute hypertensive
Benign
How is nephrosclerosis treated?
Treat HTN
Acute nephritic syndrome
glomerular diseases where kidneys become large and congested
Manifestations of Acute Nephritic Syndrome
Hematuria
Edema
Azotemia
Proteinuria
HTN
Nursing interventions for acute nephritic syndrome
Support
Dietary changes
Treat cause if known
Glomerulonephritis
glomerular disease where kidneys shrink and become fibrous
Manifestations of glomerulonephritis
Fixed SG
Casts in urine
Proteinuria
Electrolyte imbalances
Hypoalbuminemia
Nephrotic syndrome
Glomerular diseases in which there is an increase in glomerular permeability
Manifestations of nephrotic syndrome
Massive proteinuria
Edema
Hypercoaguable state
Causes of nephrotic syndrome
Lupus
Glomerulonephritis
DM
Polycystic Kidney Disease
kidney disease involving the growth of fluid filled cysts that destroy nephrons
What is the most commonly inherited cause of kidney failure?
Polycystic kidney disease
What other organs most commonly have cysts with polycystic kidney disease?
Liver and spleen
When does kidney failure happen?
When kidneys cannot remove wastes or perform regulatory functions
Acute kidney injury
a reversible syndrome that results in decreased glomerular filtration rate and oliguria
ESRD AKA
chronic renal disease
ESRD
progressive, irreversible deterioration of renal function that results in azotemia
azotemia
elevated levels of urea and other nitrogenous wastes in blood
What is assessed in a patient with CKD and AKI?
Fluid status
Nutritional status
Patient knowledge
Activity tolerance
Self-esteem
Potential complications
Complications of CKD or AKI
Hyperkalemia
Pericarditis
Pericardial effusion
Pericardial tamponade
HTN
Anemia
Bone disease with metastatic calcifications
When is hemodialysis used?
For acutely ill patients with AKI until kidneys resume function and LT replacement therapy in CKD or ESKD
What is objective of hemodialysis?
Extract toxic nitrogenous substances from the blood and to remove excess fluid
What kind of access is needed during hemodialysis?
vascular
What type of vascular access is used during hemodialysis?
Arteriovenous fistula
Arteriovenous graft
How often is vascular access assessed for AV fistula or graft?
Once a shift
Types of peritoneal dialysis
Acute intermittent
Continuous ambulatory
Continuous cyclic
Complications of PD
Peritonitis
Leakage
Bleeding
What medications must be held prior to hemodialysis?
Cardiovascular medications
Why must CV meds be held prior to hemodialysis?
Due to rapid fluid shifts that can cause hypotension
Describe the onset phase of an AKI
Triggering event occurs
Duration can be hours or days
Kidney perfusion decreases
Urine output drops below 0.5mL/kg/hr
Describe the oliguric phase of an AKI
10-14 days, sometimes longer
Urine output <400 mL/day
Describe the diuretic phase of an AKI
1-3 weeks
Increased output
Kidneys regain ability to excrete urine but not concentrate it
Hypovolemia
Hypotension
Describe the Recovery phase of an AKI
Can last up to 12 months
Gradual return to normal function
What is the GFR range in stage 1 of CKD?
> 90 mL/min
What is the GFR range in stage 2 of CKD?
60-89 mL/min
What is the GFR range in stage 3 of CKD?
30-59 mL/min
What is the GFR range in stage 4 of CKD?
15-29 mL/min
What is the GFR range in stage 5 of CKD?
<15 mL/min
