Renal disease

Question 1

what is kidney disease?

Answer 1

partial or complete impairment of kidney function

Question 2

what are 2 reasons for acute kidney injury?

Answer 2

abrupt decline in kidney function with
1) rise in serum creatinine
2) reduction in urine output

or both

Question 3

is acute kidney injury reversible?

Answer 3

potentially

Question 4

what are 3 types of acute kidney injury?

Answer 4

pre renal: reduction in circulation which then reduces renal blood flow

intra renal: direct damage to renal tissues
ex: acute tubular necrosis aka death of tissue

post renal: obstruction of urinary outflow

Question 5

what are the key manifestations for acute kidney injury?

Answer 5

increase in creating and BUN
excess potassium
metabolic acidosis

Question 6

what is the biggest complication with acute kidney injury?

Answer 6

hyperkalemia which results in dysrthmias

Question 7

what if treatment doesnt fully work?

Answer 7

use crystalloids and diuretics in attempt to perfuse kidneys

Question 8

what if treatment works?

Answer 8

fluid restriction to 600mL + previous 24 hours fluid loss
nutrition therapy

Question 9

what are the 3 renal replacement therapies?

Answer 9

1) peritoneal dialysis
2) hemodialysis
3) continuous renal replacement therapy

Question 10

what is chronic kidney disease?

Answer 10

irreversible loss of kidney function

GFR < 60ML for 3 months or longer

Question 11

how long will the kidneys survive with chronic kidney disease?

Answer 11

can survive without replacement therapy until 90% of nephrons are lost

Question 12

does chronic kidney disease go noticed or noticed?

Answer 12

usually goes unoticed because the little nephrons they are use hypertrophy to compensate

Question 13

what are clinical manifestations of chronic kidney disease?

Answer 13

manifestations occur in all body systems

Question 14

what are the chronic kidney disease diagnostic tests used?

Answer 14

protein to creatinine ratio in first morning voided specimen

Question 15

what is dialysis?

Answer 15

movement of fluid and molecules across semi permeable membrane

Question 16

what is diffusion, osmosis and ultrafiltration?

Answer 16

1) diffusion: movement of solutes from an area of greater concentration to an area of lesser concentration

2) osmosis: movement of fluid from an area of lesser to an area of greater concentration of solutes

3) ultrafiltration (water and fluid removal): occurs when there is an osmotic gradient or pressure across the membrane

Question 17

what is peritoneal dialysis?

Answer 17

catheter inserted through anterior abdominal wall

• anchored in peritoneum to prevent migration of microorganisms

Question 18

what are the 3 types of peritoneal dialysis?

Answer 18

1) inflow: prescribed amount of solution infused into catheter over about 10 times (usually 2L)

2) dwell: diffusion and osmosis occur between the patients blood and peritoneal cavity ( 20-30 minutes to 8 hours)

3) drain : takes approx 15-30min

then cycle repeats with 2L of fluid

Question 19

what are some peritoneal dialysis complications?

Answer 19

common one is exit site infection

Question 20

what is hemodialysis?

Answer 20

removing waste products and excess fluids from blood

Question 21

what is required in hemodialysis?

Answer 21

rapid blood flow is needed in order to have access to a large blood vessel

Question 22

what are the 2 types of hemodialysis?

Answer 22

1) arteriovenous fistulas and gifts (preferred bc of less complications)

2) central venous catheters

Question 23

do pts gain weight on hemodialysis?

Answer 23

yes. usually 2-3kg between treatments. this fluid can be removed in the pt’s BP is stable throughout treatment

Question 24

how long and often is hemodialysis performed?

Answer 24

treatment is 3-5 hours and minimum of 3x per week

Question 25

what is a complication of hemodialysis?

Answer 25

hypotension bc of decrease volume of fluid being removed

Question 26

discuss CRRT

Answer 26

instead of intermittent, this is continous removal of fluid over days instead of hours

key term: causes less hemodynamic instability