Renal Flashcards
What are the functions of the kidney?
- Remove waste products from the body by turning them into urine
- Remove drugs from the body
- Balance the body’s fluids
- Release hormones that regulate blood pressure (renin, erythropoietin)
- Produce an active form of vitamin D that promotes strong, healthy bones
- Control the production of red blood cells
- Electrolyte Regulation
What is Glomerular Filtration Rate?
Glomerular filtration rate (GFR) is the amount of blood that passes through the glomeruli each minute
The normal blood flow through the kidneys is 105-125 mls/min →99% is reabsorbed resulting in 1- 1.5L of urine per 24 hours
What are the 3 factors needed for urine production?
Pre-renal:
Adequate perfusion pressure (renal blood flow) and oxygenation of kidneys. If there isn’t enough pressure in the system then urine output will decrease. The kidneys may be functioning fine but if the system isn’t functioning well
Renal:
The kidney units must be functioning properly i.e. no damage to the structures in the kidney such as tubules, glomerular
Post-renal:
There must be no obstruction to urine flow
What is Oliguria?
Low Urine output. 100-400ml/day (an early warning sign related to poor urine output)
What is Anuria?
Lack of urine production. A late warning sign related to poor urine output. <100ml/day
How many hours of Oliguria can cause acute kidney injury?
Two hours
What is an acute kidney injury?
Acute kidney injury (AKI)occurs when the kidneys are unable to remove the body’s metabolic waste or perform their seven regulatory functions, in particular, Maintenance of BP and electrolyte regulation. These metabolic wastes build up in the body and GFR falls as the disease progresses
What are the three causes of Acute Kidney Injury?
Pre-Renal Causes: (Low cardiac output, low BP, severe vomiting)
Intrarenal (Intrinsic) causes (Damage to renal tissue, nephrotoxins, NSAIDS (Non-steroidal anti-inflammatory drugs)
Post-renal causes (Obstruction (kidney stones), renal calculi)
What are the 4 phases of Acute Kidney Injury and how long do they occur for?
Initiating phase hours = days
Oliguric phase = 10 - 14 days
Diuretic phase
Recovery phase = 3 - 12 months
What nursing assessments would you undertake for Acute Kidney Injury?
- Fluid balance chart (FBC)
- Daily weigh (1kg of weight = 1L retained fluid)
- Skin integrity
- Vital signs → EWS
- Capillary refill time (CRT)
- Palpate and/or scan the bladder
- Bloods – GFR, electrolytes, CBC
- Ability to manage ADLs
What are the 2 types of dialysis?
Haemodialysis
Peritoneal dialysis
What is Haemodialysis?
A machine removes blood from your body, filters it through a dialyser (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a dialysis centre three times a week.
What is Peritoneal dialysis?
During peritoneal dialysis, a cleansing fluid flows through a 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.
What needs to happen for BP to remain stable?
Need a fully functioning myocardium and kidneys
What are some risk factors for chronic kidney injury?
Diabetes
Hypertension
Smoking
Obesity
Ethnicity
Gender men>women
Age - kidney function decreases with age
Specific conditions – glomerulonephritis
What is Chronic Uramia?
Built up waste in the kidneys which the body wants to get rid of
What are the Nursing Interventions for renal?
Maintain adequate nutrition
Fluid restriction
Promote activity & rest as tolerated
Provide skin care
Provide education on condition & complications
Provide culturally appropriate care
Psychological/emotional l support
Support for smoking cessation
What are the treatment aims for renal?
Treatment is aimed at slowing the progression of the disease
Smoking cessation
Adequate BGL control
at least two alcohol free days per week
Reduce systolic BP by
reducing the BMI
moderate physical activity
reducing salt intake
What are the gerontological considerations in acute kidney injury?
Care with medications due to ↓renal function (e.g. ↓GFR & ↓nephrons)
Reduced organ function due to the normal ageing proccess
Co-existing conditions (e.g. diabetes, HF)
Polypharmacy
Dehydration (& hypotension) are poorly tolerated (care with diuretics) as is fluid overload
Older people are less able to maintain homeostasis due to cellular ageing
What is the difference between CKI and AKI?
AKI – is a medical emergency that is often associated with acute illness and occurs within a short period (days/hours)
AKI has a poor prognosis
20% of AKI is associated with medication
CKI may develop into AKI
Interventions for CKI aim to prevent progression to AKI
