RENAL Flashcards
what are some functions of the kidney
- filter blood
- remove metabolic waste
- maintain fluid balance
- balance electrolytes
- maintain acid-base balance (pH)
- red blood cell production
- control blood pressure
- vit D activation
what happens when you have chronic kidney disease
- unable to remove excess fluid, metabolic waste
- high phosphate levels
- poor appetite but increased requirements if on dialysis
how many stages of CKD and what stages would you start dialysis?
stage 1-5
- start dialysis ~ stage 4
how is GFR related to kidney function
GFR tells you how much kidney function you have
- GFR goes down as kidney function goes down
what is the GFR range
- 90 or higher to less than 15
describe peritoneal dialysis
blood is cleaned using the abdomen
- blood is cleaned inside your body using lining of the stomach that acts as a filter
- through diffusion - extra fluid and waste is left out
- can be done at home
- catheter is inserted to get the acid out
describe hemodialysis
blood flows out and the waste get filtered out with excess fluid
- cleaning happens inside the dialyser
- treatment is 2-6 hours, 3 times a week
what are the main nutrition considerations in CKD?
- potassium
- phosphate
- sodium
- fluids
- kcal/protein/vitamins and minerals
nutrition requirements for CKD Diet (stage 3-5, GFR <60) - protein, fluid, electrolytes
protein: limited protein
fluid: no fluid restriction
electrolytes: sodium <2300mg/d and potassium/phosphorus per labs
nutrition requirements for hemodialysis Diet (stage 3-5, GFR <60) - protein, fluid, electrolytes
protein: high protein
fluid: 1L + urine output
electrolytes: sodium <2300mg/d, potassium and phosphorus per labs
nutrition requirements for peritoneal Diet (stage 3-5, GFR <60) - protein, fluid, electrolytes
protein: high protein
fluid: drink to thirst, typically no restriction
electrolytes: sodium <2300mg/d, potassium and phosphorus per labs
what is the main difference between acute kidney injury and chronic kidney injury
acute - potential to recover, is irreversible
- onset is different: chronic is a progressive loss, acute is quick onset
how to calculate weight if on dialysis?
use dry weight - post dialysis weight
what labs to look at for CKD
pH regulation: GFR, HCO2, BUN, creatinine
- electrolytes: Na, K, P, Mg, Ca
- Hct, Hgb - kidneys stimulate red blood cells (anemia)
- alb, pre-alb - markers of inflammation
- vit D
what is acute kidney injury
abrupt cessation or decline in GFR that results in failure to maintain fluid, electrolyte, and acid-base balance
- associated with many clinical situations that result in a stress- or injury- induced hypercatabolic state
what are some risk factors of AKI
- age > 75
- CKD
- cardiac failure
- liver disease
- diabetes
- nephrotoxic medication use
- sepsis
what is prerenal AKI
- impaired blood flow to kidneys
- causes: hypovolemia (low extracellular fluid secondary to combing sodium and water loss) due to hemorrhage, burns, diarrhea, vomiting, inadequate fluid replacement
what is intrinsic AKI?
- damage within kidney cells
- causes: exposure to toxins such as antibiotics, chemotherapy, or contrast dyes
what is postrenal (obstructive) AKI?
- obstruction in urine flow (urinary tract obstruction)
- causes: bladder cancer, benign prostate hyperplasia, kidney stones
what are some clinical manifestations of AKI?
- low urine output
- fluid and electrolyte disorders
- azotemia - waste products in blood are too high
- wasting
treatment of AKI?
treat the underlining cause
- electrolyte imbalances: IV replacement + meds
- fluid imbalances: diuretics + dialysis
main interventions for AKI
- optimize nutrition status
- minimize uremia (urine in blood)
- preserve body protein stores until renal function returns
- maintain fluid, electrolyte, and acid-base homeostasis
energy, protein, fluid, and electrolyte interventions for AKI
energy: meet requirements and minimize lean body mass breakdown
protein: DO NOT RESTRICT PROTEIN
fluid: depends on degree of residual renal function (generally utput + 400-500mL)
electrolytes: based on labs
what is nephrolithiasis
kidney stones - crystallization of calcium, oxalate, struvite, cystine, hydroxyapatite or uric acid that is not excreted normally in the urine
factors contributing to the stone development:
- abnormal urine flow
- urine composition
- presence of renal calculi
- hydration status
- pH of the urine
risk factors of kidney stones:
- LOW URINE VOLUME
- family history
- previous stone formation
- medical conditions
- gout
- excess intake of vitamin D
diagnosis and treatment of kidney stones:
- most can pass with plenty of fluid and pain meds
- medical procedures if unable to pass
intervention of kidney stones:
goal: minimize the super-saturatio of urinary components associated with the formation of stones and to prevent stones from recurring
- increase fluid intake by 3L/d in divided doses
- ensure minimum urine output of 2L/d
- DASH diet - lowest risk for development (more fruits and vegetables and less animal proteins)
- avoid > 200mg Vitamin C a day
