Renal Flashcards
Functions of the kidneys
Acid-base balance Water removal Erythropoietin Toxin removal Blood pressure control Electrolyte balance D activation (vitamin)
GFR
105-125ml/min
preferred measure of kidney function
Serum creatinine
- 6-1.5 mg/dL
* most indicative of renal failure*
-waste product of muscle metabolism
BUN
8-20 mg/dL
*not as sensitive as creatinine
-waste product of protein metabolism
BUN to creatinine ratio
10: 1
* hydration status*
Uric acid
2-7mg/dL
End product of purine metabolism
UA abnormalities
Blood, glucose, protein, ketones
Creatinine clearance
Indicative of renal function 85-135 ml/min 24hr specimen (start and stop with empty bladder) At least 10ml/hr to avoid dialysis Done with serum creatinine
IV pyelogram
Assess for iodine allergy and renal function
IV contrast given and scan done of urinate system
May feel flushed, give fluids after
Pyelogram
Dye injected into renal pelvis and X-rays taken
Iodine allergy not quite as important because dye is not systemic
Renal US
first test used in acute renal failure, noninvasive
May show enlargement, stones, infection, tumors
Renal biopsy
Monitor for bleeding!
Pre: NPO, mild sedative
Post: vitals, pressure dressing, observe for bleeding, bed rest x24hrs, encourage fluids, no heavy lifting x 2 wks
Rules for diabetics r/t radiologic studies
Monitor kidney function
Flush contrast with a lot of fluid after study
Taking metformin, should not have contrast
Electrolytes in kidney failure
K: up Na: normal then goes up in late stages Ca: goes down Phos: goes up Mg: goes up Albumin & HCO3 goes down
RIFLE
Staging of AKI Risk Injury Failure Loss End stage renal disease
Oliguric phase of AKI
Decreased GFR
Output < 400 ml/day
Lasts 10-14 days
Manifestations: hyperK, hypoCa, fluid volume excess, metabolic acidosis, elevated BUN and creatinine
Diuretic phase of AKI
Output 1-5 L/day
Elevated urea causes osmotic diuresis
Monitor for hypoK, hypoNa, and dehydration
Unconcentrated urine
Recovery phase of AKI
GFR increases, BUN and creatinine stabilize then decrease
Can take 12 months
Most common cause of death is infection
Pre Renal biopsy mgmt
Pre: blood type and cross match, consent form, assess coag status, medical history, CBC, Hct, clotting time, stop ASA (warfarin, etc.)
Post Renal biopsy mgmt
Post: monitor for bleeding, HoTN, decreasing Hct, fever, chills, urinary frequency, dysuria, hematuria
-pressure dressing, patient to be on affected side for 30-60 min, VS q5-10 min x1 hr, bedrest x24 hrs, avoid heavy lifting 5-7 days, hold anticoagulant until discuss with HCP
Dialysis access assessment
Hear a bruit
Feel a thrill
Neurovascular assessment distal to AVG
Initial treatment for hyperkalemia
Calcium Gluconate IV (stabilize myocardium)
Insulin w/ D50 (shift K and prevent hypoglycemia)
Secondary treatment for hyperkalemia
Sodium bicarbonate and prolonged high doses of albuterol
Non acute Hyperkalemia treatments
Dietary restrictions
Patiromer-PO
Kayexalate (Sodium polystyrene sulfonate)-PO/retention enema
K wasting diuretics