Renal Disorders Flashcards
T or F: Kidney disease have super obvious symptoms.
FALSE
can have compromised functioning but no symptoms
down to a GFR of 30 before we start to see real changes, up to 90% affected
Type of things that don’t normally get through the glomerulus
proteins
large RBCs
glucose
–> bad if in urine
Functional unit of the kidney
nephron
Glomerulus
selective filtration water & solutes from blood
Bowman’s capsule
also filtration
Proximal tubule
reabsorbs about 80% of water, solutes back to blood
Loop of Henle
where loop diuretics work
e.g. furosemide
Distal Tubule
changed to be permeable or impermeable so we can have final concentration
bicarb, acid
e.g. dehydration - anterior pituitary secretes ADH to work on tubules, more permeable so water can be reabsorbed back into circulatory system
Collecting duct
all comes together and is excreted out
Afferent arterioles
a SINGLE afferent arteriole supplies blood to each glomerulus
dilation of afferent arteriole allows a great volume to go IN
Efferent arterioles
blood exits the glomerulus by the efferent arteriole
constriction of efferent=increased pressure
Urine formation processes (3)
1) glomerular filtration
2) tubular reabsorption
3) tubular secretion
Functions of the kidneys (6)
1) elimination of metabolic wastes
2) BP regulation
-angiotensin I
-angiotensin II - constriction, to raise BP
-cortex - aldosterone - fluid retention
3) erythrocyte production
-can see anemia in patients with kidney disease
4) Vitamin D activation
5) prostaglandin synthesis
-for the RAAS
6) acid–base balance
A person with respiratory distress will have a(n) _______ blood pH
acidic
respiratory acidosis
CO2
Supplements that patients with kidney disease should be on
Vitamin D - calcitriol (active form)
calcium
iron
folic acid (RBC maturation)
Labs for kidney disease
often identified through labs due to the lack of symptoms
urea
creatinine
GFR
What would LOW urine output indicate
dehydration
kidneys not getting well perfused
Why would someone with kidney disease have a HIGH urine output
wrong composition
very, very dilute
or with the wrong things, like creatinine
Chronic Kidney Disease
low GFR over 3+ months
develops slowly
1 or both:
decreased function: GFR of less than 60 mL/min
damage: urinary albumin excretion of ≥30 mg/day or equivalent
adaptive hyperfiltration
increased perfusion/filtration to the nephrons, but overtime its maladaptive and causes damage
Acute Kidney Injury
SUDDEN decline in renal function
develops over hours or days
increased BUN & Cr
oliguria <400ml/24 hrs
hyperkalemia & Na retention
Major consideration when assessing patient
how stable they are
Predisposing factors
infections requiring antibiotics
OTC meds
nephrotoxic meds
antihypertensive meds
dyes
Concerning: weight gain of more than ___ pounds/day
2 pounds
Signs that suggest extracellular fluid DEPLETION include [dehydration]
thirst, decreased skin turgor, and lethargy
Signs that imply intravascular fluid volume OVERLOAD include
pulmonary congestion, increasing heart failure, and rising blood pressure
Ongoing Assessments (4)
1) weight monitoring
2) intake/Output
3) neuro
4) hemodynamics
What is a better indicator of fluid retention?
a) urinary output
b) weight
b) weight
urine tells you about what you’re losing
Minimum urine output per hour
30 mL
BUN normal range
3.6 - 7.1 mmol/L
elevated with decreased GFR - staying in system
Creatinine normal level - male
53 - 106 mmol/L
elevated with decreased GFR
Creatinine normal level - female
44 - 97 mmol/L
elevated with decreased GFR
Normal GFR
90 - 120
only good indicator with a steady state and slow decline over time
normal BUN:Creatinine ratio
10:1
Creatinine clearance
85 - 135ml/min
Urinalysis
appearance
pH
specific gravity
osmolality
protein
glucose
ketones
electrolytes
sediment (intrarenal)
blood (hematuria)
Goal of interventions for acute kidney injury
perfuse the kidneys
not diagnose
Diagnostic procedures (many)
ultrasounds
CT
x-ray
bladder scan
contrast dye
biopsy
Considerations when giving contrast dye
lots of fluids before and after!! nephrotoxic
may need to hold meds like metformin
Top causes of chronic kidney disease (3)
1) hypertension
2) DM
3) CVD
Symptoms of Chronic Kidney Disease
EVERY SYSTEM
Goals of Care of CKD
prevent and slow!
slow progression
manage co-morbidities like DM and HF
prepare patients for RRT
Meds to avoid in CKD
nephrotoxic
NSAIDs
contrast dye
CKD Urinary System Progression
1) Polyuria
-early
-2.5-3 L/24 hours
2) Oliguria
-late
< 400ml/24 hours
3) Anuria
-late
<40 mL per 24
Type of respiration in patient with CKD
Kussmaul respiration
deep and labored
acidotic - trying to blow off excess CO2
Med for fluid overload
furosemide
GFR >30 mL: 80 mg
bad: 200 - 500 mg
What to give for metabolic acidosis
bicarb
decreased protein intake
increased fruit intake (EXCEPT if high in vitamin K)
With CKD, are you more likely to see:
a) hypokalemia
b) hyperkalemia
b) hyperkalemia
When to give pharmacological interventions for hyperkalemia
> 5.5
Pharmacological interventions
glucose
calcium gluconate
cation exchangers – ex Kayexalate
diuretics
Side effect of Erythropoietin (Epogen, Darbepoetin)
hypertension
uremic state symptoms
anorexia
N/V
pericarditis
peripheral neuropathy
CNS abnormalities (seizures, coma, death)
Treatment for uremic state
RTT
dialysis or transplant
CKD nursing care
systems assessment
maintaining skin integrity
monitoring excess fluid overload
daily weights
risk for infection
monitoring nutrition
risk for constipation
risk for injury
balancing activity and rest
patient teaching
anticipatory grieving
What values should you look at for acute kidney injury? (2)
1) creatinine
2) urine output
Types of acute kidney injuries (3)
1) prerenal
2) intrarenal
3) postrenal
Clinical course of acute kidney injury (3)
1) initiation
2) maintenance
3) recovery
Population where you’re more likely to see acute kidney injury
elderly population
renal changes
co-morbidities
Goals of care for AKI
treatment of underlying cause
manage symptoms
prevent complications
What you need to figure out for AKI care
fluid overload or depletion
Fluid depletion intervention
crystalloids - 0.9 NaCl, 0.45 NaCl
colloids – albumin, pentaspan, hetastarch
Fluid overload intervention
diuretics!
fluid restriction
RRT
What does dialysis mimic
nephrons
semi-permeable
Peritoneal dialysis
using the peritoneal cavity and lining as the semi-permeable membrane
Biggest complication from peritoneal dialysis
infection
Hemodialysis
machine is acting like the kidney
What medication is added to hemodialysis?
heparin
normal findings fistula
thrills and bruits
Palliative care goals for end stage renal disease
Symptom Management
pain
constipation
hypervolemia
N/V
delirium
