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Nursing 201 Pathophys > Renal Disease > Flashcards

Renal Disease Flashcards

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1
Q

Which artery supplies the kidneys?

How much blood passes through the kidneys per minute?

A

The renal arteries (Left and Right)

1700ml per minute (20-25% of every heartbeat)

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2
Q

Where are the kidneys positioned?

A

Retroperitoneally around the T12-L3 level

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3
Q

What part of the kidneys forms the urine?

A

In the nephrons

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4
Q

What are the functions of the kidney?

A

Acid-base balance
Water removal
Erythropoiesis
Toxin removal
Blood pressure control
Electrolyte balance
D vitamin activation

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5
Q

What is the sequence of RAAS system activation?

A
  1. Juxtaglomerular cells detect increased osmolarity and release renin
  2. Renin triggers angiotensinogen –> angiotensin 1 in the liver
  3. Angiotensin Converting Enzyme in the lungs converts angiotensin 1 –> angiotensin 2
    - Vasoconstriction
    - Pituitary secretion of antidiuretic hormone and thirst response
  4. Angiotensin 2 triggers aldosterone release from adrenal glands
    - Sodium and water retention
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6
Q

What are some measures of renal function?

A

Microalbuminuria
Glomerular filtration rate
Serum creatinine

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7
Q

What is microalbuminuria?

A

Blood albumin present in urine

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8
Q

What is glomerular filtration rate?

What is it determined by?

A

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

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9
Q

What is creatinine?

What is creatinine clearance?

A

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

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10
Q

What is acute renal disease?

Is it reversible?

A

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

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11
Q

What are the phases of acute renal disease?

A

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

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12
Q

What are some pre-renal causes for acute renal disease?

A

Ineffective perfusion of the kidneys while they are structurally normal
- Hypovolemia
- Hypotension
- Renal hypoperfusion

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13
Q

What are some intra-renal causes for acute renal disease?

A

Damage to renal parenchyma
- Acute tubular necrosis
- Nephrotoxic renal failure
- Glomerulonephritis
- Vasculitis
- Pylonephritis

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14
Q

What is acute tubular necrosis?

What colour is the urine associated with this?

A

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

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15
Q

What is acute interstitial nephritis?

A

A drug therapy reaction within the kidneys

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16
Q

What are some post-renal causes for acute renal disease?

A

Obstruction of urine flow (Treatment is to relieve the obstruction)
- Kidney stones
- Tumors/Cancers
- Fibrosis
- Benign prostatic hypertrophy
- Neurogenic bladder
- Tricyclic antidepressants
- Strictures

17
Q

What are some signs and symptoms of acute renal disease?

A

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

18
Q

What are the nursing management strategies for acute renal disease?

A

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

19
Q

What are the management strategies for hyperkalemia?

A

ECG and cardiac monitoring
IV insulin and dextrose
IV calcium gluconate
Diet considerations
- Reduce bananas, beef and oranges
Dialysis

20
Q

What are the treatment strategies for acute renal disease?

A

Treat underlying cause (e.g. infection if present)
Fluid restriction/IV fluids
Diet
Monitoring lab results

21
Q

What is chronic renal disease?

What are the symptoms?

A

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

22
Q

What are the stages of chronic renal disease?

A

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)

23
Q

What are the causes of chronic renal disease?

A

Diabetes
- Diabetic nephropathy

Hypertension

Acute kidney injury complications

Polycystic kidney disease
- Cysts in kidneys

Glomerulonephritis
- Nephron inflammation

Nephrotoxins
- Alcohol
- Some imaging contrasts
- Some medications

24
Q

What is uraemia?

A

Urea in the blood

25
Q

What can uraemia cause?

A

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

26
Q

What is anaemia?

How is it caused in chronic kidney failure?

A

Low red blood cell count

It can be caused by haemolysis due to blood urea and decreased erythropoietin secretion

27
Q

What are some symptoms of anaemia?

What are some management strategies for anaemia?

A

Symptoms:
- Pallor
- Fatigue/Lethargy
- Shortness of breath
- Confusion

Management
- Subcutaneous erythropoietin
- Iron, B12, Folic acid, blood transfusions

28
Q

What causes metabolic acidosis?

A

Impaired renal excretion of acids and impaired reabsorption of bicarbonate

29
Q

What are some symptoms of fluid overload?

A

Oedema
Weight gain
Increased blood pressure
Breathlessness

30
Q

What are the management strategies for fluid overload?

A

Daily weight

Monitoring BP and respiratory status
- Listening to lung sounds

Monitor fluid input and output
- Fluid restrictions

Assessing oedema

31
Q

What is end-stage renal disease?

A

When glomerular filtration rate has fallen below 15ml/min

32
Q

What are the treatment options for end-stage renal disease?

A

Haemodialysis

Peritoneal dialysis

Transplant

33
Q

What does dialysis do?

A

Removes waste products, toxins, and excess water

34
Q

What is peritoneal dialysis?

How often does the dialysate bag need to be changed per day?

A

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

35
Q

What are some risks of peritoneal dialysis?

What are some drawbacks of peritoneal dialysis?

What are some positives of peritoneal dialysis?

A

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

36
Q

What is haemodialysis?

How often do patients undergo haemodialysis?

A

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.

37
Q

What is an arteriovenous fistula?

Why is this done for haemodialysis?

A

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

38
Q

What are some drawbacks of haemodialysis?

What are some positives of haemodialysis?

A

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

39
Q

What are some drawbacks of haemodialysis?

What are some positives of haemodialysis?

A

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

Nursing 201 Pathophys (29 decks)

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