Nephrotoxicity, RF, nephropathy Flashcards
What is nephrotoxic?
poisonous to the kidney
Why do you want to monitor input/output (I/O) and daily weight gain?
For indication of low urine production, fluid retention, edema
Why do you want to monitor fluid and electrolyte imbalance?
Could indicate hyperkalemia or hypervolemia
What is acidosis? And why is it important to note with Nephrotoxicity?
an abnormal condition characterized by reduced alkalinity of the blood and of the body tissues; patient will need to be monitored for acid-base imbalance
What does RF stand for?
rheumatic fever
What is hypovolemia?
a decrease in the volume of circulating blood in the body
In what type of patients should nephrotoxic drugs specifically be avoided?
Patients with hypovolemia
What are common forms of Nephrotoxic drugs?
- NSAIDS
- ACE
- ARB
- diuretics
- certain abx
- IV contrast dye
What is an ACE inhibitor?
any of a group of antihypertensive drugs (such as captopril) that relax arteries and promote renal excretion of salt and water by inhibiting the activity of angiotensin converting enzyme
What is the typical increase in fluid intake for a patient with Nephrotoxicity?
2-3 L/day
What should be monitored on the renal panel for patient with Nephrotoxicity?
- BUN (the concentration of nitrogen in the form of urea in the blood)
- creatinine (a white crystalline strongly basic compound C4H7N3O formed from creatine and found especially in muscle, blood, and urine)
- GFR (glomerular filtration rate)
Why is a patient with nephrotoxicity at risk of toxicity?
Poor excretion of the drug/poor metabolites
What is Proteinuria (nephrotic syndrome)?
the presence of excess protein in the urine
What is Hematuria (nephritic syndrome)?
the presence of blood or blood cells in the urine
A patient with Nephrotoxicity may need dialysis. List and describe three.
- hemodialysis: Hemodialysis is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or entrance, into your blood vessels. This is done with minor surgery, usually to your arm.
- peritoneal dialysis: a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.
- CRRT: Continuous renal replacement therapy is a special type of dialysis that we do for unstable patients in the ICU whose bodies cannot tolerate regular dialysis. It is a very different type of dialysis from the routine type that patients may be familiar with, and it requires special skills and expertise. Regular hemodialysis is meant to be mostly an outpatient procedure. It is done usually three times a week for three to four hours at a time. The flow rates used to clear waste products and remove fluid from the patient are very fast, potentially putting stress on a patient’s heart and blood pressure. If a patient already has a low or unstable blood pressure or has heart issues, he or she will not tolerate regular dialysis. CRRT is a slower type of dialysis that puts less stress on the heart. Instead of doing it over four hours, CRRT is done 24 hours a day to slowly and continuously clean out waste products and fluid from the patient. It requires special anticoagulation to keep the dialysis circuit from clotting.
