renal Flashcards
risk factors associated with kidney disorders
Low birth weight which can lead to reduced nephron endowment and lower renal volume Chemical or environmental toxin exposure Contact sports/trauma Diabetes mellitus Family history of renal disease Frequent urinary tract infections Heart failure High-sodium diet Hypertension Medications Race, ethnicity
aging and kidneys
amount of kidney tissue decreases and kidney function diminishes
number of nephrons decrease
blood vessels supplying the kidneys can become hardened causing the kidneys to filter blood more slowly
aging and bladder
bladder wall changes = elastic tissue becomes stiffer and the bladder becomes less stretchy, bladder cannot hold as much urine as before
the bladder muscles weaken
the urethra can become partially or totally blocked
chronic kidney disease (CKD)
The progressive loss and ongoing deterioration in kidney function
Characterized by a glomerular filtration rate (GFR) of less than 60 mL/minute for a period of 3 months or longer
Progression based on degree of proteinuria
It is irreversible and results in uremia or end-stage kidney disease (ESKD)
CKD requires dialysis or kidney transplantation to maintain life
ckd associated labs and clinical manifestations
Creatinine and Urea
As glomerular filtration rate (GFR) declines, the plasma creatinine increases by a reciprocal amount to maintain a constant rate of excretion.
GFR goes down and creatinine and urea go up
Fluid and electrolyte balance
When the GFR decreases to 25% there is an obligatory loss of 20 to 40 mEq of sodium per day with osmotic loss of water.
Ultimately the kidney loses its ability to regulate sodium and water balance causing retention of sodium and water = edema and hypertension.
Total body potassium can increase to life-threatening levels and must be controlled by dialysis
Calcium, Phosphate, and Bone
Changes begin when the GFR decreases to 25% or less
Hypocalcemia is accelerated by impaired renal synthesis
Renal phosphate excretion decreased and the increased serum phosphate binds calcium, further contributing to hypocalcemia.
Acidosis contributes to a negative calcium balance
Decreased serum calcium levels stimulate parathyroid hormone secretion to mobilize calcium from bone.
Ultimately increases risk of fractures
Protein and Albumin
Monitor protein and albumin excretion in patients with chronic renal failure
Repeated measurement of the urine protein- or albumin- to-creatinine ratio every few months, using a first-morning void whenever feasible
ckd neurological manifestations
Asterixis (tremor of the hand when the wrist is extended)
Ataxia (alteration in gait)
Coma
Inability to concentrate or decreased attention span
Myoclonus (involuntary twitching of a muscle or a group of muscles)
Paresthesias (sensation of tingling, tickling, burning)
Seizures
Slurred speech
ckd cardiovascular manifestations
Cardiac tamponade (cardiac filling is impeded by an external force) Cardiomyopathy Heart failure Stroke Pericarditis Hypertension Pericardial effusion Peripheral edema Dyslipidemia Ischemic Heart Disease Sudden cardiac death
ckd respiratory manifestations
Crackles because of pulmonary edema
Deep sighing, yawning
Depressed cough reflex
Kussmaul’s respirations in response to Metabolic Acidosis
Pulmonary hypertension due to LV dysfunction or uremic-associated vascular changes
Pleural effusion (result of extra volume, tissues become leaky)
Shortness of breath in response to pulmonary edema, pulm HTN
Tachypnea- required to improve gas exchange
Unpleasant “uremic” breath odour
ckd GI manifestations
Anorexia Changes in taste acuity and sensation Constipation Uremic gastroenteritis Nausea Vomiting GI bleeding Diarrhea
ckd hematologic manifestations
Noromochromic-normocytic anemia Impaired platelet function Decreased platelet numbers and altered vascular endothelium promote increased bleeding Hypercoagulability Alterations in thrombin and other clotting factors contribute to hypercoagulability what conditions are these patients at risk for if they are hypercoagulable??? Lethargy Dizziness Low hematocrit
ckd immune system
Suppressed immune system: Chemotaxis Phagocytosis Antibody production Cell-mediated immune responses Malnutrition Metabolic acidosis Hyperglycemia ^ increase immunosuppression Deficient responses to vaccinations Increased risk for infection Virus associated cancers (EBV, HPV, Hep B and C)
ckd integumentary manifestations
Uremic frost Decreased skin turgor Dry skin Ecchymosis Pruritus Purpura Yellow-gray pallor
ckd urinary manifestations
Diluted, straw-colored appearance Hematuria Oliguria (later) Polyuria (early) Proteinuria
ckd msk manifestations
Bone pain
Muscle weakness and cramping
Pathological fractures
ckd reproductive manifestations
Decreased fertility
Decreased libido
Impotence
Infrequent or absent menses
