Renal Flashcards
What is the mean onset age of CKD? Males or females?
Mean age is 7
Affects more males than females
What is the role of the renal vein? Renal artery?
Renal vein: transports clean blood out of kidney
Renal artery: transports blood with waste into the kidney so the kidney can filter the blood
What are the major functions of the kidneys? (9)
- Regulates fluids and osmolarity
- Regulates electrolytes
- Regulates acid/base
- Removes metabolic waste (urea)
- Excretes medications and toxins
- Regulates BP
- Simulates RBC production via producing hormones
- Synthesizes hormones (RAAS, erythropoetin)
- Regulates bone formation (conversion of vitamin D and site of action for PTH)
What is the role of amniotic fluid?
Urine and kidney development
GI development
Lung development
What is a baby born with in relation to the kidneys? What happens if you are premature?
Born with total nephron mass
Preemies (before 37 weeks) have low mass so they are at increased risk of CKD
How long do kidneys grow for?
Grow through puberty
When do the tubules mature? What does immature tubules affect?
Mature at 2 years
Infants unable to concentrate urine –> excessive dilute urine
Less responsive to ADH, aldosterone
Naturally higher potassium
Transient acid/base disturbances
More prone to dehydration
What is creatinine dependent on?
Muscle mass
More muscle –> higher creatinine
What is the normal creatinine for an infant? Preschooler? School age? Adolescent?
Infants: < 0.2
Preschool: 0.4
School age: 0.6
Adolescent: 0.8-1
What is the relationship between serum creatinine and GFR?
inverse relationship
SMALL changes in serum creatinine –> GFR decreases significantly
GFR goes down by 50% every time creatinine is doubles
Is bed wetting common?
Yes
At what age are UTI diagnosed and treated differently?
Under 2 and over 2
What should be used to confirm a UTI? How can you get urine from a child that is not potty trained?
Urine culture
Straight cath
What are 3 things that are necessary for normal kidney function?
- Good blood flow to the kidney
- Healthy tissue within the kidney
- Unobstructed urinary tract so it allows for urinatation
What is prerenal AKI? is it common?
Sudden and severe reduction in blood pressure (shock) and interruption of blood flow to kidneys from severe injury or illness
Most common
What are the causes of pre-renal AKI?
Blood loss
Dehydration (vomit, diarrhea)
Heart failure
Sepsis
Vascular occlusion
What is intrinsic (intra) renal AKI?
direct injury to kidneys by inflammation, drugs, toxins, infection, or reduced blood supply
What are the causes of intrinsic (intra) renal AKI?
Acute tubular necrosis (drugs, toxins, prolonged hypotension, autoimmune, infection)
Glomerulonephritis
Small vessel vasculitis
What is post renal AKI? What are the causes?
Urine obstruction
Kidney stones
Congenital anomaly of urinary tract (CAKUT)
Vesicoureteral reflux
Hydronephrosis
What does one year of AKI mean?
CKD
What are the long term complications of CKD? (6)
Growth failure
Anemia
Endocrine disorders (delayed puberty)
Metabolic abnormalities and bone deformities
Neurocognitive delays
CVD (inflammation, vascular tone and HTN, edema)
What is a common cause of death in children with CKD?
cardiac issues d/t highly inflammatory
What are causes of loss of water and electrolytes?
Fever
GI suction
Vomiting and diarrhea
Diaphoresis
Increase UOP
What are the s/s of water and electrolyte losses?
Irritability
Dry mucous membranes
Increased thirst
Decreased skin turgor
UOP less than 1ml/kg/hr
Dark colored urine and high urine specific gravity
Sunken eyes
Decreased tears
Lethargy
Depressed fontanels
What are nephrotoxic agents?
Contrast media
TPN
Drugs (NSAIS, antibacterials, antivirals, immunosuppressants, antineoplastic, angiotensin-converting enzyme inhibitors, diuretics, anti-ulcer (cimetidine), PPI, lithium)
Anesthetics
What is Uteteropelvic junction obstruction?
What is posterior urethral valve? What is the concern in utero? What is the concern if you are born with this?
Valve at bladder where it meets the uretra so completely obstructs urine
In utero - urine goes back into the kidney and squishes kidney tissue
Born with this –> poor lung development b/c amniotic fluid is important for lung development
What is vesicoureteral reflux?
Shoots urine back to kidney
Usually needs transplant
What is hydronephrosis mean?
Urine/water on the kidney
Who is CAKUT most common in? What does it cause?
Males
Causes a post renal condition
What are the complications of CAKUT?
CKD
Neurogenic bladder
Hydronephrosis
Recurrent UTI (constant collection of urine)
When should a catheter culture be obtained?
Under 2
Does CAKUT effect the genitalia?
Yes - abnormal genitalia
How does CAKUT lead to urinary obstruction/disrrupt the stream of urine?
Phimosis - foreskin too tight
Epispadias: uretra too high
Hypospadias: urethra too low
Cryptorchidism: undescended testicle
How is cryptorchidism treated? What does it increase the risk for?
Surgery 6-15 months (post op - infection, pain, UOP)
Increased risk of testicular cancer
Why is increased potassium at risk if kidney issues? How can potassium be removed from the body? What else should be monitored?
Kidneys excrete potassium from the body
Diuretics (furosemide), bicarb, k-exalate
Strict I&Os and EKG
If a child is already dehydrated and you add sodium such as with normal saline what occurs?
It can further damage the kidney
What is the bladder regimen for a child with CAKUT?
intermittent cath 5 times a day
Why does a child with CKD need iron and GH shots and nutritional supplement?
GH because they don’t grow well and are short
Iron because they are usually anemic
Nutritional supplement because they protein/muscle waste
What nursing interventions for post renal AKI? (9)
Diuretics/anti HTN
Strict I&Os, daily weight, and girth
Labs
Unine specimen
Avoid Na, K, and phos in diet
CV and BP assessments
EKG
Neuro and resp assessments
Medications to avoid
What type of AKI are glomerular diseases?
infrarenal
Who does nephrotic syndrome affect? What is the cause?
Toddlers
Genetic, environmental
Most kids grow out of it
What are the s/s of nephrotic syndrome?
Proteinura >4+
Normal serum creatinine
Low albumin level in blood (hypoalbuminemia <2mg/dL) so fluid goes into tissues
Significant fluid volume overload
+/- HTN
What is the treatment for nephrotic syndrome?
Steroid (corticosteroids) for 12 weeks minimum
Low sodium and fluid restriction
Diuretics
Albumin (before diuretics to pull fluid back to vessels)
Vaccines
Hand hygiene
What is the priority concern regarding nephrotic syndrome?
Fluid volume overload
Fluid volume deficit d.t all fluids in tissues
What are the complication of nephrotic syndrome?
Infections
Peritonitis
Sepsis
Thrombosis (blood thick and sluggish)
Cushing syndrome (long term steroid use)
Who does glomerulonephritis affect?
School age and teens
What are the s/s of glomerulonephritis?
Proteinuria AND hematuria
Elevated serum creatinine
Fluid overload varies
Azotemia
ALWAYS HTN
Decreased H&H
What are two types of glomerulonephritis?
Post infectious glomerular nephritis (PIGN)
Hemolytic uremic snydrome (HUS)
What is PIGN? Treatment?
Post strep infection –> glomerulonephritis
Self-limiting
What is HUS? What if you require RTT d/t this?
E. coli infection –> glomerulonephritis
Wide spread in spectrum and severity
If require RRT –> high risk for CKD and eventually need transplant
Is glomerulonephritis or nephritis worse?
glomerulonephritis look sick but usually is self-limiting with treating s/s
What does a raw hamburger cause?
HUS d/t E. coli
