Renal

Question 1

5 main functions of the kidneys

Answer 1

1. removing waste products
   -> FILTERING fluid of the blood
   -> REABSORBING the filtered fluid back into the blood
   -> SECRETING out toxins and waste products into urine
2. controlling acids, bases, electrolytes and fluid
3. controlling blood pressure
4. production of erythropoeitin
5. activation of vitamin D

Question 2

Renal failure

Answer 2

is the broad term for the loss of kidney function, which can be acute or chronic, leading to the accumulation of waste products in the body.

Question 3

Acute Kidney Injury (define and types)

Answer 3

sudden decline in renal function => decrease fluid, electrolyte, and pH balance

Causes
1. pre-renal: reduced blood flow to kidneys = not enough pressure in the capillaries to push the fluid out and filter it

• hypovolemia, hypotension, haemorrhage, burns, loss of fluid, septic shock, heart failure, stenosis of the renal artery

2. intrarenal: direct damage to kidneys
   - acute tubular necrosis (damage to nephrons => nephrons die)
   - glomerulonephritis
   - CKD
3. post-renal: obstruction of urine flow
   - urinary tract obstruction

Question 4

Acute Kidney Injury- Nursing management

Answer 4

1. assess for decreasing renal function (labs)
   a. glomerular filtration rate (AKI = decreased by 25%)
   b. urea (increased) (normal: 3.2-7.7mmol/L)
   c. creatinine (increased) (normal: 45-90umol/l)
   d. oliguria (<0.5mg/kg/mL)
2. treat underlying cause
   a. prerenal: IV fluids +/- diuretics
   b. intrarenal: IV fluids, antibiotics, CT dye, diuretics
   c. postrenal: catheterisation, surgery
3. Assess and treat for what the kidney should filter out and did not
   a. fluid overload
   b. azotemia
   c. hyperkalemia
   d. metabolic acidosis
   e. hypernatremia
   f. hypoalbuminemia
4. assess for problems with other kidney functions
   a. anemia
5. assess for infection

Question 5

Chronic Kidney Disease (define, causes, s/s)

Answer 5

progressive, irreversible loss of nephrons leading to dysfunction

Causes:
a. diabetes: hyperglycemia causes inflammation and cell destruction in both the kidney cells and in blood vessels
b. hypertension:
c. Acute kidney injury that did not resolve

Grades:
normal: 100mL/min
grade 3 (symptoms onset): <60mL/min
grade 4 (severe): <30mL/min
grade 5 (kidney failure): <15mL/min

S/s: (due to uraemia and azotaemia)
- nausea and vomiting
- diarrhea
- anorexia
- weight loss
- muscle wasting and bone pain
- oedema
- hypertension
- peripheral neuropathy
- pericarditis
- pruritis
- frost

s/s: (from not filtering enough)
- oedema in abdomen, legs and feet, jugular vein distension, SOB, crackles in the lungs, bounding pulse
- hypernatremia/ hyponatremia

s/s: (from not controlling BP)
- hypertension

s/s: (from not producing erythropoetin or activating vit D)
- anaemia
- hypocalcaemia = bone weakness

Question 6

Chronic kidney disease- nursing management

Answer 6

• low sodium and potassium diet
• low phosphate diet (dairy products)
• minimise NSAIDs use
• fluid restrictions
• treat electrolyte and RBC imbalance (phosphate binders, calcium supplements, vit d, iron supplements, erythropoeitin injection)
• monitor and treat fluid imbalance
• discuss dialysis

Question 7

Dialysis

Answer 7

• indicated by severe renal failure
• manual filtering of blood
• through vessels: femoral artery/vein, jugular veins, subclavian veins

Principles of dialysis therapy:
- blood is removed from the patient and passed across a semipermeable dialysing membrane
- the size of the membrane pores determines which substances can leave the blood
- wastes diffuse down their concentration gradient into dialysing solution
- to prevent loss of useful substance like glucose and calcium ions, they are added to dialysing fluid

Question 8

Dialysis- patient consideration

Answer 8

1. proper scheduling
2. monitor for side effect of dialysis (e.g. weight changes)
3. monitor for complications during dialysis (hypotension, muscle cramps, bleeding from cath site)

Question 9

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Answer 9

• the dialysing fluid (typically a few litres) is administered (via a permanent catheter) into the abdomen cavity and the peritoneum acts as the dialysing membrane
• the person can then mobilise for the next few hours while waste diffuse from the blood across the peritoneum and into the dialysing fluid
• after a few hours they reconnect the catheter to the empty dialysis fluid bag, place it lower than their abdomen, and allow gravity to drain off dialysing fluid + waste it now contains
• biggest risk = infection
• aseptic practice prevents peritonitis
• can do 3-4 cycles a day
• after 1 year, peritoneum becomes less effective, patient may consider haemodialysis or kidney transplant