Renal (Acute and Chronic) Flashcards
Describe 2 types of acute kidney injury
Prerenal- hypoperfusion of kidneys
Intrarenal-direct damage to kidneys (prolonged renal ischemia)
Postrenal= obstruction to the flow or urine
Describe examples prerenal injury
Prerenal- hypoperfusion of kidneys
EX:
low blood pressure, dehydration, hypovolemia/hemorrhage, shock/sepsis, anaphylasix, cardiac efficiency reduced (heart failure, cardiogenic shock, dysrhythmias)
Describe examples Intrarenal injury
Intrarenal= direct damage to kidneys (prolonged renal ischemia)
EX:
drugs, (NSAIDS, gentamycin, tobramycin, ACE inhibitors), Contrast mediums, toxins (solvents and chemicals), crush injury (results in myogloginiuria- burns), blood transfusion reaction, acute infections like acute pyelonephritis and glomerulonephritis
Describe Post Renal injury
Postrenal= obstruction to the flow or urine
Ex:
Stones, tumours, enlarged prostate, strictures and blood clots
Describe 4 phases of renal injury
Initiation, Oliguria, diuresis and recovery
What is Renal Failure (Basic)
- Results when kidneys cannot remove the bodies metabolic wastes or perform their regulatory fx
- Substances normally eliminated in the urine accumulate in the body and disrupt endocrine fx, metb fx, lyets, and acid-bases balance
- Systemic disease
fxs of kidney
Urine formation Excretion of waste products Regulation of electrolytes Reabsorption of vital nutrients Acid base homeostasis Control of water balance Renal clearance Blood pressure regulation Hormone secretion (erythropoietin-regulation of rbc production) Synthesis of Vitamin D to active form
Describe phase 1 initiation
basically the initial insult. Watch output and labs
Describe Oliguria Phase
- Rise in serum concentration of substances usually secreted by the kidneys (urea, creatinine)
- Minimum amount of urine needed to rid the body of normal metb wastes is 400 mL
- Uremic symptoms appear and life-threatening conditions such as hyperkalemia develop
- Pts can have normal amounts of urine (2L a day) but still have decreased renal fx →considered nonoliguric form and occurs with nephrotoxic damage
Describe the diuresis phase
- Gradual increasing of urine output signaling GFR has started to recover
- Lab values (urea) start to decrease
- Observe closely for dehydration in this phase
Describe the Recovery phase
- May take 3 to 12 months
* A permanent 1-3% reduction in GFR is common but not clinically significant
What is Azotemia
Literally “urine in the blood”
Build-up of nitrogenous waste products unable to be excreted adequately by the kidneys
Why might renal disease lead to SOB and Lethargy?
Kidneys produce erythropoietin which stimulates bone marrow to produce Red blood cells- in renal injury this does not happen therefore less RBCs, less hemoglobin available to carry oxygen, anemia and shortness of breath follow.
Nutritional deficiencies and tendency to bleed in
GI tract from azotemia (along with shortened lifespan of RBC) all contribute to anemia.
Lethargy can be due to anemia (as above) or also due to effects of low sodium levels, metabolic acidosis, or azotemic symptoms (brain encephalopathy)
What is the affect of kidney failure on acid base balance?
Kidneys can’t excrete the extra loads of acid and they can’t reabsorb the bicarbonate
Metabolic Acidosis due to accumulation of sulfates, phosphates and uric acid may cause altered enzyme activity or cardiac and neuronal membranes by the promotion of hyperkalemia due to excess acids. High potassium, high phosphate and low bicarb levels aggravate acidosis
What are the symptoms of Acidosis?
Headaches, nausea and vomiting, abdominal pain, rapid shallow respirations, low plasma bicarb (review your ABG notes and classes here), low blood ph (less than 7.35). Acidosis affects the central nervous system so this can increase neuromuscular irritability due to cellular exchange of hydrogen and K.
What sort of medical interventions might be required with metabolic acidosis?
IV infusion of sodium bicarbonate? Treat underlying cause of kidney failure- hemodialysis if interventions are ineffective.
What are the symptoms of hyponatremia?
Why might these present in kidney failure?
Weakness, lethargy to coma, CNS effects (cellular edema causes cerebral edema), adb pain, muscle twitching, cramps and convulsions, N and V and diarrhea.
Patient may become dehydrated in diuresis phases which would cause loss of water and sodium from body, may also be on NA restriction in diet, or vomiting/diarrhea from metabolic acidosis all which may contribute to low NA
May also be insufficient salt in diet
Why might kidney failure lead to hyperkalemia?
Kidneys decreased ability to excrete potassium and/or excessive potassium in diet. Acidosis also further increases release of K from cells into blood stream.
Main issues of FVE?
Interventions?
Pulmonary edema, systemic edema, weight gain, HTN.
Strict Ins/Outs Fluid/diet restriction (NA) Elevate head of bed Diuretic as ordered Watch IV and input carefully Minimal dilution of IV meds Oxygen as ordered Weigh patient daily
What can be done to treat hyperkalemia?
Medications to lower potassium = IV glucose or IV dextrose; retention enema to facilitate exchange of NA and K ions in the colon.
Correct metabolic acidosis (bicarb infusion) which further draws K out of cells and into blood stream
Hemodialysis if above medications and therapies fail to work
What are the Risk factors of Chronic Kidney Disease
Diabetes (and poorly controlled) is number one risk factor
Hypertension, non-compliance with medications
Uncontrolled hyperglycemia
Heart disease
Undetected acute kidney injury
What would you expect to find in CKD in relation to these lights?
K, NA, CA, Ph
K+ Potassium= high
NA= Sodium= high or low depending on stage
Ca= Calcium=low
Phosphate =high
Describe the effects of Uremia (Renal Failure) on the systems of the body
Hematologic: kidneys make eryropoetin so not enough produced= low RBC count- low platelets, low hb = tired, SOB, risk of bleeding
Cardiovascular- Sodium and water retention from renin-angiotensin-aldosterone system= heart failure, pitting edema, pericarditis (irritation of pericardium due to uremic build-up of toxins) hypertension, high K can cause arrythmias
Immunologic- immunosuppressed
Neurologic- Uremia, ICP, low sodium levels can cause seizures, muscle cramps, coma
Musculoskeletal- bone disease due to retained (increased )phosphorous decreased calcium, Vit D- affected
Endocrine- thyroid and parathyroid dysfunction
Metabolic- tubular cell in kidneys malfunction and can’t rid body of accumulation of acids (phosphorous, sulpuric) therefore metabolic acidosis- patient may need bicarbonate IV
GI- affected and often results in GI bleeds (also linked to low platlets)
Dermatologic- build up of nitrogenous wastes in skin- crystals, itchiness, uremic frost
Critical indicators that a patient requires Dialysis
High potassium levels Uremic encephalopathy Uncontrollable metabolic acidosis Heart failure Total body fluid overload leading to unresponsive pulmonary edema and inability to restore normal fluid balance
Complications of hemodialysis
Infection of venous access site and sepsis, pneumonia (common) uremic symptoms, cardiac and respiratory complications, hypertension, clotting of vascular access device, fluid volume maintenance during dialysis, pain and discomfort, patients undergoing hemodialysis often have low platelets (watch for clotting/bleeding etc) and low WBC counts (infection) and low RBC (anemia)
Complications of peritoneal dialysis
Peritonitis (most serious complication usually caused by staph A., E.coli and Klebsiella), leakage, bleeding, hypertriglyceridemiaabdominal hernias, low back pain and constant sweet taste related to glucose absorption
Priorities during acute Renal failure
hyperkalemia (arrythmias) is the key, Pulmonary edema is 2nd
Interventions for Hyperkalemia
Kay Exalate, diuretic, dialysis