Renal Disorder Management Flashcards
What issues may arise if there are problems with the kidneys?
Fluid volume shifts
Protein deficits
Electrolyte Imbalances
Metabolic acidosis
Why does metabolic acidosis occur? What electrolyte imbalance is most likely to occur?
The kidneys can’t excrete the acidic H+ and cannot reabsorb bicarb leading to acidosis.
Hyperkalemia occurs with metabolic acidosis. So pay attention to cardiac issues and smooth muscle contractions.
Main categories or statuses of renal failure?
Acute Kidney Injury and End stage renal disease.
They are different but on the same spectrum.
What are chronic kidney diseases?
They are what they sound like. Kidney diseases that go on for a long time. It is an umbrella term. And yes, they can cause renal failure not managed properly.
Acute Nephritic Syndrome is what?
This is an umbrella term again.
Most common acute nephritic syndrome?
How many types are there?
Glomerulonephritis.
Can be acute or chronic.
What is glomerulonephritis?
What can happen if left unmanaged?
Inflammation of the glomeruli which leads to filtration issues.
If not treated it can make things a lot worse for the kidneys due to scar tissue
What are common infections that can cause glomerulonephritis?
Strep
Bacterial endocarditis
Hep B & C
HIV
Autoimmune disease that can cause glomerulonephritis?
Lupus
Goodpasture’s
Two very manageable diseases that cause glomerulonephritis?
Hypertension
Diabetes
(due to scarring)
What is vasculitis? Can it cause glomerulonephritis?
It is inflammation of blood vessels.
It too can cause glomerulonephritis.
How to describe symptoms of acute glomerulonephritis?
flu-like: lethargic and malaise
What will urine output appear as in the acute stages?
Low urine output with hematuria at this stage.
What will the BUN and creatinine levels be like in acute stage?
Azotemia or excess of these in the blood
Symptoms like edema, hypertension, headache, and vision problems are common for which type of glomerulonephritis?
They are actually found in both types. Acute and Chronic.
What labs are checked for glomerulonephritis?
What diagnostics?
Any that has to do with kidneys.
Protein Electrolytes ABGS BUN & Creatinine WBC H&H GFR Throat culture (due to strep)
Basic diagnostics are used and Biopsy
Why do we use diuretics when treating glomerulonephritis?
Because diuretics allows us to control fluid balance and helps control electrolytes.
Just need to pick the right diuretic. Probably not going to pick a potassium sparring tho.
Why is it so important to monitor nutrition with a glomerulonephritis patient?
(or really any pt with kidney issues)
We don’t want a build up of compounds that can lead to toxicity.
We also don’t want to contribute to the illness that caused the patients status.
Be careful about the protein you give.
Be careful about salt.
Know which tests the patient has ordered and anticipate that they may need to be NPO
What medications might you give for glomerulonephritis?
These meds don’t treat the glomerulonephritis. But they help precipitant factors which is key
Antibiotics
Immunosuprresants
Corticosteroids (anti-inflammatory properties)
Education for the glomerulonephritis patient?
Need to educate on whichever condition landed them their current status.
HTN, Diabetes, strep, HIV, HEP, Lupus, Good pasture’s, etc
What is the main cause of Chronic glomerulonephritis?
Repeat episodes of acute glomerulonephritis
Why does Hypertensive nephrosclerosis lead to chronic glomerulonephritis?
If someone doesn’t control their HTN, nephrosclerosis can develop. And with that, glomerulonephritis can settle in.
Hyperlipidemia is associated with acute glomerulonephritis. T/F?
False. Hyperlipidemia is associated with chronic.
How do chronic glomerulonephritis symptoms present?
The symptoms can go unnoticed for years.
In chronic glomerulonephritis, what will the patient’s physical appearance look like?
They will lose weight and muscle, so thin.
Glomerular damage can cause chronic glomerulonephritis. What are some things that cause the damage?
Hypertension
Sclerosis
etc
What else happens in urination once someone has chronic glomerulonephritis?
Nocturia or peeing urge at night
Chronic glomerulonephritis can progress to Chronic Kidney Disease. Symptoms that overlap or occur?
edema anemia dry skin night cramps mental status change
What labs do we do for chronic glomerulonephritis?
All the same ones as acute!
Chronic glomerulonephritis trend for potassium, phosphorus, and hydrogen
Increased.
Chronic glomerulonephritis trend for calcium, albumin, and bicarb
Decreased.
What will H&H results show?
Decreased which is related to anemia
Management goals that also apply with chronic glomerulonephritis?
What might the patient have to do if the kidneys are really shot?
Control HTN Fluids Electrolytes Nutrition Infections
Patient may have to go on dialysis.
How to prevent Acute/Chronic glomerulonephritis?
Treat
Control
Avoid
Change
Treat this:
strep
impetigo
Control these: HTN Diabetes Lupus Good pastures
Avoid these:
HIV
Hep
Change these: salt intake protein potassium obesity
What is Nephrotic Syndrome?
Glomerular disease that involves damage to glomerulus blood vessels. Not inflammation and not apart of acute nephritic syndrome
Patho of Nephrotic syndrome?
Due to damage of vessels proteins escape into the urine. Edema occurs due to the lack of albumin and protein for oncotic pressure.
Causes of nephrotic syndrome (5)
Chronic glomerulonephritis due to its ability to progress.
Diabetic Neuropathy which is also a cause for ^.
Glomerulsclerosis
Lupus
Multiple myeloma
Risk factors of nephrotic syndrome
Diabetes
HIV
Hep
NSAIDS - due to toxicity with OD. Think of ibuprofen.
so basically the same as any kidney issue but with the addition of NSAIDS
Nephrotic Syndrome symptoms
Edema
Ascites
Weight gain
Foamy urine
Fatigue
Circumstances of nephrotic syndrome edema?
How to treat edema and ascites?
Periorbital or eye edema
Dependent edema or when legs are low.
Make sure to do skin care. You can also raise legs but make sure that doesn’t cause any issues. We can always deal with edema later. Can also administer diuretics.
Diet needs for nephrotic syndrome patients?
low sodium
low protein
low cholesterol
Complications that can occur with nephrotic syndrome
high blood cholesterol and triglycerides poor nutrition HTN acute kidney injury renal failure
What is renal failure?
When kidneys can no longer remove waste and do their job
What are the different renal failures?
Acute kidney injury
End Stage Renal Disease
What is acute kidney injury? Is it reversible?
It is an immediate & sudden decline of the kidneys that can lead to failure but it is reversible
Criteria to be considered an Acute Kidney Injury?
Creatinine levels will be increased
UO will be less than 0.5 mL/kg/hr for 6 consecutive hours
Due to loss of function what state occurs?
Azotemia or build up of nitrogenous waste products like BUN and creatinine
Possible causes of acute kidney injury?
Loss of blood
Hypovolemia
Anaphylactic shock to radiology dye
Elderly considerations for acute kidney injury
Are they dehydrated? Do they have access to water? Do they just drink soda? etc
Staging acronym for renal failure
Risk Injury Failure Loss of Function End stage renal disease
RIFLE
Describe or sum up pre-renal acute kidney injury cause
Something that results in hypo-perfusion or less perfusion to the kidneys.
Examples of triggers that cause hypo-perfusion & why? (4)
Diarrhea, Vomiting
NG Suction
Decrease CO
Sepsis
So if you lose fluids, that affects your blood. If you can’t give adequate CO, that affects perfusion. Sepsis due to decrease in venous blood return.
Urine volume per day with pre-renal?
Sodium in the urine?
Specific gravity?
less than 400 ml/day UO
Urine sodium will be low
Specific gravity will be increased indicating dehydration.
What is intra-renal acute kidney injury?
Common causes? (8)
When the damage is to the kidney itself.
Pylenophritis glomerulonephritis
Malignant HTN
eclampsia
ischemia from prolonged hypo-perfusion
nephrotoxic drugs
contrast media
Amino-glycosides antibiotics that end in
-mycin
What is the main post-renal cause of acute kidney injury?
Examples?
Just an obstruction of urine.
Stone
Tumor
Enlarged Prostate
Stricture
What are the phases of the acute renal injury?
Onset
Oliguric
Diuretic
Recovery
What is the onset?
What does it cause?
The triggering event occurs.
A toxic or ischemic insult to the kidneys which causes UO to drop below 0.5/ml/kg/hr
Oliguric phase urine output?
Labs?
Electrolytes? (easy now)
Fluids?
BP?
UO of less than 400 ml/day
Creatinine and BUN increased
Altered electrolytes
Fluid excess
BP is hypertensive
Diuretic phase is when?
GFR rate?
UO?
BUN and creatinine?
Electrolytes and UO?
Renal tubules ?
It is when the AKI event is corrected.
GFR rate increases
UO increases to 4000ml/day
Slow increase of BUN and creatinine
Electrolytes depleted with more UO
Renal tubules scarred and edematous
Recovery phase
edema?
F&E?
GFR?
edema is decreased
fluid & electrolytes return to normal
GFR is 70-80% normal now
When in recovery phase, what must we do?
follow up with them to make sure things are going smoothly.
educate them on prevention
Diet
Hydration
Meds
Meds for acute kidney injury?
4
diuretics
analgesics
vitamins
beta blockers
Why might the patient go on dialysis?
It just depends on their state
What is chronic kidney disease?
Is it reversible?
Known as chronic renal failure also.
Loss of renal function over a long period of time.
It is not reversible
What does chronic kidney disease lead to?
What is required at that point?
End stage renal disease
Renal replacement therapy or transplant
What is the most common cause of end stage renal disease?
Hypertension
Diabetes
Why does hypoxia occur in chronic renal disease?
What does that cause?
Due to reduced capillary perfusion.
Causes fibrosis and cell injury
Proteinurea in chronic kidney disease?
due to glomerular hypertension
What to avoid to prevent chronic kidney disease (or even manage it)?
BG and HTN spikes
NSAIDS
UTI
Nephrotoxic agents
if creatinine goes up, what does that mean for the GFR?
The gfr must decrease for creatinine to go up.
How do we treat pulmonary issues?
pulmonary edema
pleural effusions
uremic pneumonitis or urea build up with creatinine
Diuretics for excess fluid in the heart and lungs.
Morphine for anxiety and pain.
BP drugs
Digoxin
How to treat CV issues?
HTN
Dysthrymia
Pericarditis
administer anti-hypertensives
administer anti-dysthymics
Medication and procedures to drain fluid or remove pericardium
Treating Hematological issues?
Bleeding and anemia
Erythpoetin injection
and Monitor bleeding
Treating GI issues? Bleeding anorexia n/v GERD
A lot of these can be fixed with the right meds.
anorexia addressed through working with patient
Neuromuscular issues
sleep disturbances
muscle irritability
peripheral neuropathies
Sleep meds.
Muscle irritability - fix the electrolytes
control Diabetes
possible skin issues?
pruritis
bronze/gray skin
uremic frost on skin
Muscoleksletal issues
CA
PO
PTH
bone pain and fractures
replace vitamins and give correct hormone replacements
- watch and wait also an option
Go review the dialysis slides on your kahoot
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