Regulatory disorders of kidneys Flashcards
Main causes for chronic kidney disease
Diabetes, hypertension, glomerulonephritis, pyelonephritis, polycystic or congenital disorders, renal cancer
More than 20% of the US population age 20 years and older have hypertension with chronic kidney disease.
Glomerular filtration rate GFR
Amount of plasma filtered through the glomeruli per unit of time.
Azotemia
Abnormal concentration of nitrogenus wastes in the blood
Glomerulonephritis is inflammation of glomerular capillaries.
When does it occur?
And what happens to the kidneys?
Occurs usually after an infection:
Strep, impetigo, shingles, hep B, HIV.
Kidneys become large, damages, and congested. All renal tissues are affected
Care for glomerulonephritis
Reduce protein
Daily weight
End stage renal disease (EKSD)
Retention of uremic wastes and the need for renal replacement therapies, dialysis or kidney transplant.
Symptoms of chronic glomerulonephritis
Maybe no symptoms for many years.
Hypertension,
elevated BUN and serum creatinine levels. Decreased weight and strength,
irritability
nocturia, headaches, dizziness and digestive disturbances
Symptoms of chronic kidney disease
Poorly nourished appearance, peripheral Edema, hypertension, abnormal retinal findings,
anemia,
enlarged heart and other symptoms of heart failure and fluid overload
Mental status changes
Diagnostic findings of chronic kidney disease as renal failure progresses and GFR falls below 50
Proteinurea, urinary casts (which is proteins secreted by damaged kidney tubules)
Hyperkalemia and acidosis due to decreased potassium and acid secretion and inability to regenerate bicarbonate
Anemia- decreased RBC production.
Hypoalbuminemia,
increased phosphorus and decreased calcium
Impaired nerve conduction/ abnormal ekg due to electrolyte abnormalities
What is nephrotic syndrome?
Type of renal failure Characterized by increased glomerular permeability and is manifested by massive proteinuria.
Liver is still increasing production of albumin but it cannot keep up with the daily loss of albumin through the kidneys.
What are clinical manifestations and symptoms of nephrotic syndrome?
Protein in urine particularly albumin,
decrease of albumin in the blood,
hyperlipidemia.
Pitting edema in dependent areas such as sacrum, ankles, hands and periorbital Edema,
ascites,
irritability, headache and malaise
(Main answer would probably be edema and albumin in urine)
What are some complications of nephrotic syndrome?
Infections due to deficient immune response,
thromboembolism especially of the renal vein,
pulmonary embolism,
AKI do to hypovolemia,
atherosclerosis due to hyperlipidemia
Treatment of nephrotic syndrome
Slowing progression of CKD,
diuretic for Edema,
ace inhibitors to reduce proteinuria,
lipid lowering agent for hyperlipidemia
What is polycystic kidney disease PKD?
Genetic disorder characterized by growth of numerous cysts in the kidneys.
Cysts are filled with fluid and destroy the nephrons.
Can profoundly enlarge kidneys and result in reduced kidney function and lead to kidney failure.
What are the signs and symptoms of PKD polycystic kidney disease?
Loss of renal function, hematuria, polyuria, hypertension, renal calculi, UTIs proteinuria.
Also abdominal of fullness and flank pain
Treatment of polycystic kidney disease
No cure
includes blood pressure control, pain control and antibiotics to resolve infections.
Renal replacement therapy is indicated once the kidneys fail.
What are three types of acute kidney injury?
Prerenal- hypoperfusion of kidney
Intrarenal- damage to kidney tissue
Postrenal- obstruction to urine flow
Causes of prerenal AKI
Pre-renal is approximately 60 to 70% of cases.
Result of impaired blood flow caused by:
Volume depletion such as burns, hemorrhage, G.I. losses,
hypotension
sepsis,
shock,
renal artery stenosis
Causes of intrarenal AKI
Damage to glomeruli or kidney tubules,
acute tubular necrosis,
Causes of postrenal AKI
Obstruction distal to the kidney by renal calculi, structures, blood clots, BPH, malignancies and pregnancy
What are the four phases of acute kidney injury? With brief descriptions.
Initiation: begins with initial insult and ends when oliguria develops
Oliguria.: Increase in serum concentration urine. Life-threatening conditions such as hyperkalemia develop.
Diuresis: gradual increase In urine output, urine output may reach normal or elevated levels but renal function may still be abnormal.
Recovery: improvement of renal function may take 3 to 12 months
Azotemia
Nitrogen in blood
Characterized by abnormally high levels of nitrogen containing compounds such as urea, creatinine, various body waste compounds in the blood
Most immediate life-threatening imbalance seen in acute kidney injury
Hyperkalemia
Ensure the patient is not taking an extra potassium through food, parenteral fluids, or medications.
neurological Symptoms of End stage kidney disease or chronic renal failure
Weakness and fatigue, confusion, disorientation, tremors, seizures, restless legs, peripheral neuropathy with severe pain and burning on soles of feet
What is the predominant cause of death in ESKD?
Cardiovascular disease
Integumentary symptoms of end-stage kidney disease
Gray bronze skin color, dry flaky skin, pruritus, Ecchymosis, purpura, Thin brittle nails, course thin hair
Cardiovascular symptoms of end-stage kidney disease
Hypertension, pitting edema, periorbital Edema, pericardial friction rub, engorged neck veins hyperkalemia hyperlipidemia
Pulmonary symptoms of end-stage kidney disease
Crackles, thick tenacious sputum, depressed cough reflex, pleuritic pain, shortness of breath, tachypnea, Kussmaul respirations
Gastrointestinal symptoms of end-stage kidney disease
Ammonia odor to breath “uremic fetor” Metallic taste, mouth ulcerations and bleeding, anorexia nausea vomiting, constipation or diarrhea, bleeding from G.I. tract
Hematologic symptoms of end-stage kidney disease
Anemia,
thrombocytopenia
Muscular skeletal and reproductive symptoms of end-stage kidney disease
Muscle cramps,
loss of muscular strength,
bone pain, bone fractures,
foot drop,
infertility, testicular atrophy,
amenorrhea
Three types of dialysis
Hemodialysis: procedure that circulates the patient’s blood through an artificial kidney to remove waste products and excess fluid.
Peritoneal dialysis: procedure that uses patients peritoneal membrane as the semi permeable membrane to exchange fluid and solutes
Continuous renal replacement therapies: Circulating patient’s blood through a Hemofilter
Common complications of dialysis
Episodes of shortness of breath between dialysis treatments as fluid accumulates.
Hypotension: nausea and vomiting, diaphoresis, tachycardia
Muscle cramping
Bleeding -if blood lines separate or in needles become dislodged.
Dysrhythmias, air embolism
What dietary restrictions apply to hemodialysis patients?
Restriction of: dietary protein, sodium, potassium, phosphorus and fluid intake.
Continuous renal replacement therapies may be indicated for which type of patients?
Patients with acute or chronic renal failure who are too clinically unstable for traditional hemodialysis,
patients with fluid overload secondary to oliguric renal failure
patients whose kidneys cannot handle their acutely high metabolic or nutritional needs
What are kidney stones called?
Why do they form?
Urolithiasis - condition that involves presence renal calculi
Causes: Parathyroid dysfunction, abnormal Uris acid metabolism,
excessive calcium intake,
Lack of fluid
Immobility
Symptoms of renal calculi
Paroxysmal renal calculi— sudden, sharp, severe pain that radiates through thigh and genital area
Nausea, vomiting Diaphoresis Dysuria Hematuria Pyruria- pus in urine
Name and describe four types of nephrolithiasis
- Calcium stones are the most common type of kidney stones. They are usually made of calcium and oxalate (a natural chemical found in most foods), but are sometimes made of calcium and phosphate.
- Uric acid stones form when your urine is often too acidic. Uric acid can form stones by itself or with calcium.
- Struvite stones can happen when you have certain types of urinary tract infections in which bacteria make ammonia that builds up in your urine. Struvite stones are made of magnesium, ammonium and phosphate
- Cystine stones are made of a chemical that your body makes naturally, called cystine. Cystine stones are very rare, and happen in people who have a genetic disorder that causes cystine to leak from the kidneys into the urine.
What is the difference between urolithiasis and nephrolithiasis?
Urolithiasis refers to stones originating anywhere in the urinary system, including the kidneys and bladder.
Nephrolithiasis refers to the presence of such stones in the kidneys. …
The condition is called ureterolithiasis when a calculus is located in the ureter.
What kind of fistula is used most often for hemodialysis?
The arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis (HD)
How do you check patency of AV fistula?
Assess for patency at least every 8 hours.
Palpate the vascular access to feel for a THRILL or vibration that indicates arterial and venous blood flow and patency.
Auscultate the vascular access with a stethoscope to detect a BRUIT or “swishing” sound that indicates patency.
