Renal Disorders

Question 1

Reabsorption

Answer 1

from tubules into bloodstream

Question 2

Secretion

Answer 2

from bloodstream into tubules to be excreted

Question 3

Function of the Kidneys (3)

Answer 3

1. Secretion of Erythropoetin
2. Endocrine control of calcium and phosphate metabolism (vit D)
3. Catabolism of hormones

Question 4

Glomerular Filtration

Answer 4

filtering of blood through kidney vessels (glomeruli)

Question 5

Serum Abnormalities

Answer 5

1.BUN= inc. w/ RF
2.creatinine=inc. w/ RF
3. creatinine clearance= best ;Volume of blood (mL) that kidneys can clear of creatine in 1 minute
4. GFR= permeability, vascularity, filtration
5.BUN:Creatinine ratio
nL=10:1, RF=20:1

Question 6

Chronic Kidney Failure

Answer 6

Progressive and irreversible destruction of kidney structure

Question 7

Causes of Chronic Kidney Failure

Answer 7

Chronic glomerular disease, chronic infections, congenital abnormalities, vascular disease (HTN), Obstruction (stones), Lupus, Nephrotoxic, Endocrine disorders (Diabetic Nephropathy)

Question 8

Stages of Chronic Kidney Disease

Answer 8

1- nL/increased GFR
2- mild reduction in GFR
3. moderate reduction in GFR
4. Severe reduction in GFR
5-Kidney failure/end stage

Question 9

Uremic Syndrome

Answer 9

what it is: Waste products in blood stream

S/S: Itchy, dry skin,
Yellow/grey color
N/V, lack of appetite
Anemia/bleeding (d/t platelet damage)

Manifestations:
hyperkalemia, hyperphosphatemia, hypocalcemia, hypervolumnia, anemia, Hypertension

Question 10

Uremic Encephalopathy

Answer 10

damage to brain tissue; Lethargy, Decreased alertness, Loss of recent memory, Delirium, Coma, Seizures, Muscle twitching

Question 11

Uremic Neuropathy

Answer 11

damage to nerves; Restless leg syndrome, Parathesias, Atrophy, Paralysis

Question 12

Calciphylaxis

Answer 12

Fatal syndrome of vascular calcification, thrombosis, and skin necrosis

Question 13

Violaceous

Answer 13

purple, black, leathery skin lesions

Question 14

Tx for Chronic Renal Failure

Answer 14

synthetic erythropoetin (Epogen), dialysis, diuretics, ACE inhibitor/Beta blocker to manage BP, alkalizing, Iron/folic acid supp, vitD/calcium

diet: low sodium/potassium, fluid restriction, quality protein

Question 15

Hemodialysis

Answer 15

The process of separating elements in a solution by diffusion across a semi-permeable membrane down a concentration gradient; 3-6 hours to complete

Question 16

Peritoneal dialysis

Answer 16

Solution infused between visceral & parietal components of the peritoneum (peritoneal cavity); increased risk for infection, Tenckhoff catheter, more flexible for patient

Question 17

Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)

Answer 17

An automated cycler is used to perform 3-5 exchanges during the night during sleep. In the morning, one exchange dwells for the entire day

Question 18

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Answer 18

3-4 times during the day and 1 time at night, normal diet, fewer blood transfusions

Question 19

Principles of Dialysis

Answer 19

Osmosis (L–>H), Hydrostatic pressure (H–>L), temperature (direct relationship with rate), rate of blood flow

Question 20

Complications from Hemodialysis

Answer 20

Hyper/hypovolemia, hemolysis, Dialysis Disequilibrium Syndrome, transfusion Reaction, Physical Discomfort, Body Image issues, grief, fear dependence

Question 21

Acute Kidney Injury (AKI)

Answer 21

what it is: rapid decline in renal function

Cause: hypovolemia, cardiovascular disorders, sepsis, renovascular obstruction, vasoconstriction, decreased perfusion of kidneys, ureteral obstruction, bladder obstruction, urethral obstruction (BPN), intrarenal causes (ATN)

S/S: daily increase in creatinine and urea nitrogen; oliguria, anuria

Question 22

Phases of Acute Kidney Injury (3)

Answer 22

1. Oliguric
2. Diuretic
3. Recovery

Question 23

Oliguric Phase

Answer 23

what it is:low urine output, daily increase of BUN/Creatinine

S/S: infection, edema, hyperkalemia, metabolic acidosis,hypervolemia

Tx: loop diuretic, AVOID neg nitrogen balance, Kayexalate, restrict protein, IV fluids, I & O, mental status

Question 24

Diuretic Phase

Answer 24

Urine output starts to increase (7-10days)

watch for dehydration, electrolyte balance, replace fluids, daily weight

Question 25

Recovery Phase

Answer 25

3-12 months, convalescent phase