Renal 2 bc 1 isn't enough Flashcards
Acute renal failure is what causing 4 things
Sudden decrease in renal function. causing: disruption in fluid, elytes, acid/base decreased GFR retention of nitrogenous waste products increase creatinine
ARF is NOT a what and is a what
not disease is a common pathway
3 parts to ARF what makes them special?
prerenal: decreased persfusion
intrarenal: parenchymal (renal tissue) disease ex: inflam
postrenal: obstruction
ARF BUN:Creatinine levels, high low means
high: >20 pre-renal, volume problem, BUN very high
low <10: intrarenal, tubules failing reabsorb less urea
pre-renal ARF is from what?
decreased perfusion hypovolemia, hypotension, HF renal art obstruction Burns over use of diuretics edema, ascities Drugs: ARB, ACEI, NSAIDS
Pre-Renal ARF gets what kind of GRF and s/s, what happens when prolonged
low GFR: oliguria
high specific gravity and osmolality–bc of low volume. Low urine Na
azotemia
prolonged: ATN intrinsic
how to tx pre-renal ARF
increase perfusion
Volume replacement, dialysis
Post-renal ARF is what, causes what
obstruction distal to kidney
increased pressure in bowman capsule due to backed fluid, impedes GFR
longer exposed to toxins more like to damage
Post-renal early phase adapts how, last how long
adapts: relex to maintain GFR is afferent arteriolar dilation (enhances glomerular perfusion)
12-24h
Post-renal late phase what time does it start, progression in what causes what
after 12-24hr and afferent arteriolar dilation stops
progressive decrease in perfusion- decrease GFR causes anuria. if obstruction continues can get ischemia- nephron loss
Recovery phase of post renal ARF 4 things happen, 1 sorta bad thing
when relief of obstruction pre-renal vessels relax perfusion restored GFR increased in nephrons that survived tubular pressure returns to normal BUT calyses and collecting system can remain Dilated depending on the severity of the damage.
Intrarenal/Intrinsic failure is what
dysfunction of nephron/kidney
results in ATN
Intrarenal/Intrinsic failure causes ATN can be cause by:
nephrotoxic: contrast
Ischemic: sepsis
intrarenal failure patho 2 processes
Vascular: decreased blood flow, hypoxia and vasoconstriction
Tubular: inflam, reperfusion injury, cast obstruction causes increased tubular pressure
ATN has 3 phases
prodromal
oligaric
post-oliguric
Prodromal phase of ATN
the insult has occurred
Oligaric phase when, UOP, s/s
1-2weeks (up to 8) after injury
UOP 50-400ml/day
s/s: azotemia, oliguris, progressive uremia, decreased GFR, hypERvolemia, hypERk, uremic syndrome
dialysis maybe needed
Post-oliguric phase what happens how long
diuresis but tubular function impaired and azotemia continues
fluid volume deficit until kidney recovers
2-10day (up yr) for BUN:C to normalize
usually a degree of renal insufficieny persists
ARF predictors of mortality include
oliguria, increased severity of illness, acute MI, stroke, sz
cause of death usually infection
Chronic renal failure definition
decreased kidney function/damage for 3 months
GFR <60ml/min/1.73m2
Progressive to irreversible
kidney compensates until…
70-80% nephron damage
decreased GFR with nephron loss
CKD risk factors
DM, HTN, recurrent pyelo, glomerulonephris, >65yrs old, family hx, polycystic kidney,
primary focus for mgmt of CKD 4
mgmt of ATN and HTN
ACEI ARB to decreased proteinuria
glucose control in DM
HTN and CV disease cause what, tx with
hypervolemia, atherosclerosis, heightened RAAS/SNS activity
ACEI ARB…mainly ARB
