Renal Disease Flashcards
Which artery supplies the kidneys?
How much blood passes through the kidneys per minute?
The renal arteries (Left and Right)
1700ml per minute (20-25% of every heartbeat)
Where are the kidneys positioned?
Retroperitoneally around the T12-L3 level
What part of the kidneys forms the urine?
In the nephrons
What are the functions of the kidney?
Acid-base balance
Water removal
Erythropoiesis
Toxin removal
Blood pressure control
Electrolyte balance
D vitamin activation
What is the sequence of RAAS system activation?
- Juxtaglomerular cells detect increased osmolarity and release renin
- Renin triggers angiotensinogen –> angiotensin 1 in the liver
- Angiotensin Converting Enzyme in the lungs converts angiotensin 1 –> angiotensin 2
- Vasoconstriction
- Pituitary secretion of antidiuretic hormone and thirst response - Angiotensin 2 triggers aldosterone release from adrenal glands
- Sodium and water retention
What are some measures of renal function?
Microalbuminuria
Glomerular filtration rate
Serum creatinine
What is microalbuminuria?
Blood albumin present in urine
What is glomerular filtration rate?
What is it determined by?
The volume of blood filtered by the glomerulus into the bowman’s capsule per unit of time. An estimation of functional renal mass
It is determined by the filtration rate in each nephron and the number of functioning nephrons
What is creatinine?
What is creatinine clearance?
Creatinine is a waste product from creatinine phosphate.
Creatinine clearance is the amount of creatinine leaking into the urine and can be a sensitive indicator of glomerular filtration rate
What is acute renal disease?
Is it reversible?
Acute renal disease is an abrupt decline in renal function/glomerular filtration rate leading to an increase in serum creatinine and/or blood urea nitrogen
It can usually be reversible
What are the phases of acute renal disease?
Initiating phase
- Either oliguria or anuria
Oliguric phase
- 1-7 days after injury and lasting 5-15 days
- Sometimes no oliguria, but oliguria and anuria are possible
Diuretic phase
- Can last from 1-3 weeks
- Increase in urine output
- Watch for hypovolemia, hypotension, hypokalemia
Recovery phase
- Several weeks up to a year
- Decreasing serum urea and creatinine
What are some pre-renal causes for acute renal disease?
Ineffective perfusion of the kidneys while they are structurally normal
- Hypovolemia
- Hypotension
- Renal hypoperfusion
What are some intra-renal causes for acute renal disease?
Damage to renal parenchyma
- Acute tubular necrosis
- Nephrotoxic renal failure
- Glomerulonephritis
- Vasculitis
- Pylonephritis
What is acute tubular necrosis?
What colour is the urine associated with this?
Acute tubular necrosis is the sloughing of epithelial cells within the kidneys with a decline in renal function (decreased urine output)
Urine may look muddy brown
What is acute interstitial nephritis?
A drug therapy reaction within the kidneys
What are some post-renal causes for acute renal disease?
Obstruction of urine flow (Treatment is to relieve the obstruction)
- Kidney stones
- Tumors/Cancers
- Fibrosis
- Benign prostatic hypertrophy
- Neurogenic bladder
- Tricyclic antidepressants
- Strictures
What are some signs and symptoms of acute renal disease?
Changes in urination
Nausea and vomiting
Loss of appetite
Fatigue
Increased BP
bleeding
Oedema
Shortness of breath
Breath odour/metallic taste
Bruising
Blood tests
Arrhythmia
Hyperkalaemia
What are the nursing management strategies for acute renal disease?
Reviewing blood tests
Accurate fluid balance charts
Daily weight
Daily review of fluid and nutritional state
Serum bicarbonate measured at least daily
Regular assessment for infection/sepsis/bleeding
What are the management strategies for hyperkalemia?
ECG and cardiac monitoring
IV insulin and dextrose
IV calcium gluconate
Diet considerations
- Reduce bananas, beef and oranges
Dialysis
What are the treatment strategies for acute renal disease?
Treat underlying cause (e.g. infection if present)
Fluid restriction/IV fluids
Diet
Monitoring lab results
What is chronic renal disease?
What are the symptoms?
Significant, irreversible decrease in renal function/glomerular filtration rate over a long period of time
No symptoms until the glomerular filtration rate drops significantly
- Hypervolemia
- Proteinuria
- Haematuria
- Increased urea, creatinine, potassium and phosphate in the blood
What are the stages of chronic renal disease?
Stage 1 - 100-90% functionality
Stage 2 - 89-60% functionality
Stage 3a - 59-45% functionality
Stage 3b - 44-30% functionality
Stage 4 - 29-15% functionality
Stage 5 - Less than 15% functionality (Kidney failure)
What are the causes of chronic renal disease?
Diabetes
- Diabetic nephropathy
Hypertension
Acute kidney injury complications
Polycystic kidney disease
- Cysts in kidneys
Glomerulonephritis
- Nephron inflammation
Nephrotoxins
- Alcohol
- Some imaging contrasts
- Some medications
What is uraemia?
Urea in the blood
What can uraemia cause?
Itching - dry skin and excretion of urea via sweat glands
Confusion - Urea can cross the blood-brain barrier resulting in decreased responsiveness and possibly seizures
Bleeding - Platelet dysfunction
Poor nutrition - nausea and vomiting, Loss of appetite due to metallic taste
What is anaemia?
How is it caused in chronic kidney failure?
Low red blood cell count
It can be caused by haemolysis due to blood urea and decreased erythropoietin secretion
What are some symptoms of anaemia?
What are some management strategies for anaemia?
Symptoms:
- Pallor
- Fatigue/Lethargy
- Shortness of breath
- Confusion
Management
- Subcutaneous erythropoietin
- Iron, B12, Folic acid, blood transfusions
What causes metabolic acidosis?
Impaired renal excretion of acids and impaired reabsorption of bicarbonate
What are some symptoms of fluid overload?
Oedema
Weight gain
Increased blood pressure
Breathlessness
What are the management strategies for fluid overload?
Daily weight
Monitoring BP and respiratory status
- Listening to lung sounds
Monitor fluid input and output
- Fluid restrictions
Assessing oedema
What is end-stage renal disease?
When glomerular filtration rate has fallen below 15ml/min
What are the treatment options for end-stage renal disease?
Haemodialysis
Peritoneal dialysis
Transplant
What does dialysis do?
Removes waste products, toxins, and excess water
What is peritoneal dialysis?
How often does the dialysate bag need to be changed per day?
Peritoneal dialysis involves a catheter being inserted into the peritoneal space and uses the peritoneal membrane to filter waste products and toxins
The bag needs to be changed 4 times per day
What are some risks of peritoneal dialysis?
What are some drawbacks of peritoneal dialysis?
What are some positives of peritoneal dialysis?
Risks:
- Hernia
- Peritonitis
- Exit site or tunnel infection
Drawbacks
- No baths
- Swimming restrictions
- Body image impacts
- Every day dialysis
Positives
- Quick to train (5 days minimum)
- Portable
- Needleless
- Less restriction on diet and water intake
What is haemodialysis?
How often do patients undergo haemodialysis?
Haemodialysis takes blood and filters it outside the body before returning it back to the body
Patients undergo dialysis around 3 days a week for 4-5 hours.
What is an arteriovenous fistula?
Why is this done for haemodialysis?
An arteriovenous fistula is the joining of an artery directly into a vein
It is done for haemodialysis to create a strong vessel for needle access
What are some drawbacks of haemodialysis?
What are some positives of haemodialysis?
Drawbacks
- Attached to a machine
- Needles
- Training for 12 weeks plus 8 weeks for self-care
- Hard to travel
- Fistula body image impacts
- Diet and fluid restrictions
Positives
- Only 3 times a week
- No permanent tube
- Swimming and baths are possible
What are some drawbacks of haemodialysis?
What are some positives of haemodialysis?
Drawbacks
- Attached to a machine
- Needles
- Training for 12 weeks plus 8 weeks for self-care
- Hard to travel
- Fistula body image impacts
- Diet and fluid restrictions
Positives
- Only 3 times a week
- No permanent tube
- Swimming and baths are possible
