Renal Flashcards
glomerulonephritis patho
acute can lead to chronic
- inflammatory reaction in glomerulus (filter of the kidney)
- antibodies lodge in glomerulus causing scarring and decreased filtering
- main cause is strep group A
S/sx of glomerulonephritis
flank pain (costovertebral angle / CVA tenderness)
decreased UOP (oliguria)
hematuria (rusty or coke colored urine)
proteinuria
periorbital edema
increased BP
FVE
urine specific gravity increases (concentrated)
azotemia (abnormally high BUN and creatinine)
malaise and headache due to toxins
glomerulonephritis treatment
get rid of cause (usually strep) I&O / daily wts diuretics monitor BP restrict fluids balance activity with rest dietary needs (increase carbs and decrease sodium and protein) dialysis
How do you determine fluid replacement?
24 hr fluid loss + 500 mL
Client Teaching for glomerulonephritis
diuresis begins 1 to 3 wks after onset
blood and protein may stay in urine for months
teach s/sx of renal failure
S/sx of renal failure
mailaise, headache, anorexia, N/V, decreased output and wt gain
Nephrotic Syndrome patho
inflammatory response in glomerulus (big holes form so protein leaks out)
hypoalbuminemic (low albumin in blood due to loss of protein)
albumin helps you retain fluid in the vascular space so now that we don’t have it, it leaks into interstitial space (EDEMA)
decreased blood volume due to edema so kidneys activate the renin-angiotensin system to produce ALDOSTERONE
aldosterone retains sodium and water, but since there’s no albumin, it all leaks into tissues and interstitial space
ANASARCA = total body edema
problems: anasarca, no albumin, FVD, blood clots, increased cholesterol and triglycerides
Nephrotic Syndrome Causes
idiopathic, but related to:
bacterial or viral infections
NSAIDS
cancer / genetic
systemic dzs such as lupus or diabetes
Nephrotic Syndrome S/sx
massive proteinuria
hypoalbuminemia
edema (anasarca)
hyperlipidemia
Nephrotic Syndrome Treatment
diuretics
ace inhibitors to block aldosterone secretion
prednisone to decrease inflammation
cyclophosphamide (decreases immune response)
- shrinks holes so protein can't get out - immunosuppressed - infection is major complication of nephrotic syndrome
diet - client can become malnourished fast
- decreased sodium - moderate protein (1-2 g/kg/day) / not limiting protein!
lipid lowering drugs
anticoagulation therapy for up to 6 mo
dialysis
Acute Kidney Injury (AKI) Causes
Pre-Renal Failure - blood can’t get to kidneys
- hypotension - bradycardia (arrhythmia) - hypovolemic - shock
Intra-Renal Failure - damage in the kidney
- glomerulonephritis or nephrotic syndrome
- malignant HTN and diabetes
- acute tubular nephrosis (damage to the filter)
- hypotension, sepsis, drugs
- dyes used in heart cath and CT scan
- drugs (aminoglycosides and NSAIDs
Post-Renal Failure - urine can’t leave kidney
- enlarged prostate - kidney stone - tumors - ureteral obstruction - edematous stoma (ileal conduit)
*goal - reverse it to prevent chronic renal failure
Four Phases of AKI
initiation phase (injury occurs)
oliguric phase (output may be <100 mL / 24 hr)
diuretic phase (kidney recovering)
recovery phase (3-12 months)
S/sx of Acute Kidney Injury
Creatinine and BUN increase
specific gravity increase (may lose ability to concentrate and dilute urine)
HTN - retaining fluids
HF - retaining fluids
Anorexia, N/V - retaining toxins
itching frost (uremic frost) (ensure good skin care)
retain phosphorus –> serum Ca is decreased –> calcium is pulled from bone
anemia (not enough erythropoietin)
Hyperkalemia (fatal arrhythmias)
metabolic acidosis (unable to filter or retain hydrogen or bicarb)
Treatment of Acute Kidney Injury
Nursing Measures:
- bedrest to decrease metabolism and caloric needs
- TCDB
- monitor I&Os / daily wts
- 1 kg = 1 L
- VS
Meds:
- loop diuretics or osmotic diuretics - IV glucose and insulin to treat hyperkalemia - IV calcium gluconate for dysrhythmias - polystyrene sulfonate to decrease potassium - phosphate binding drugs to prevent hypocalcemia - give any IV meds in the smallest volume allowed
Nutrition:
- increase carbs and fats - low sodium - avoid food / fluids high in phosphate - avoid foods high in potassium like bananas, citrus, and coffee
Prevent infection (mouth care / no catheters)
Renal Replacement Therapy
oliguric phase
10-14 days
diuretic phase
begin when output increases
fluid and electrolyte replacement
recovery phase
client placed on increased protein and increased calories
resume activity as tolerated
Renal Replacement Therapy
replace kidney function (hemodialysis, continuous renal replacement therapy, peritoneal dialysis)
started when BUN and creatinine levels can’t be decreased
FVE is compromising heart and lungs
Hyperkalemia and metabolic acidosis can’t be treated successfully
problems associated with protein loss
blood clots (the proteins that prevent clotting are gone)
increased cholesterol and triglycerides (liver tries to compensate by releasing more albumin which increases cholesterol and tris)
Hemodialysis
done 3-4 x a week
watch what you eat or drink between treatments
anticoagulants during to prevent blood clots (heparin)
depression (suicide / watch for drastic and dangerous diet changes)
before dialysis, assess fluid status (wt, BP, edema)
electrolytes and BP monitored constantly (30-60 min)
need access to large vein (300 to 800 mL/min)
- AVF and AVG (surgery required) - temporary (internal jugular or femoral / no surgery required)
** unstable cardiovascular system can’t tolerate hemodialysis
arteriovenous fistula
AVF
anastomosis between an artery and vein
need weeks to mature before ready for venipuncture
arteriovenous graft
AVG
synthetic graft to join vessels
need weeks to mature before ready for venipuncture
Care of dialysis access
do not use for IV access (meds, drawing blood, etc.)
no BP, needle sticks, or constriction on that extremity
- ensure patency by palpating for thrill and auscultate for bruit
- thrill (cat purr / palpate)
- bruit (turbulent blood flow / auscultate)
Continuous Renal Replacement Therapy (CRRT)
ICU setting / continuous so no drastic fluid shifts
never more than 80 mL of blood out of body at one time to not stress CV system
used when client has fragile cardiovascular system and acute kidney injury
