Renal Disorders Flashcards
Reabsorption
from tubules into bloodstream
Secretion
from bloodstream into tubules to be excreted
Function of the Kidneys (3)
- Secretion of Erythropoetin
- Endocrine control of calcium and phosphate metabolism (vit D)
- Catabolism of hormones
Glomerular Filtration
filtering of blood through kidney vessels (glomeruli)
Serum Abnormalities
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
Chronic Kidney Failure
Progressive and irreversible destruction of kidney structure
Causes of Chronic Kidney Failure
Chronic glomerular disease, chronic infections, congenital abnormalities, vascular disease (HTN), Obstruction (stones), Lupus, Nephrotoxic, Endocrine disorders (Diabetic Nephropathy)
Stages of Chronic Kidney Disease
1- nL/increased GFR 2- mild reduction in GFR 3. moderate reduction in GFR 4. Severe reduction in GFR 5-Kidney failure/end stage
Uremic Syndrome
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
Uremic Encephalopathy
damage to brain tissue; Lethargy, Decreased alertness, Loss of recent memory, Delirium, Coma, Seizures, Muscle twitching
Uremic Neuropathy
damage to nerves; Restless leg syndrome, Parathesias, Atrophy, Paralysis
Calciphylaxis
Fatal syndrome of vascular calcification, thrombosis, and skin necrosis
Violaceous
purple, black, leathery skin lesions
Tx for Chronic Renal Failure
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
Hemodialysis
The process of separating elements in a solution by diffusion across a semi-permeable membrane down a concentration gradient; 3-6 hours to complete
Peritoneal dialysis
Solution infused between visceral & parietal components of the peritoneum (peritoneal cavity); increased risk for infection, Tenckhoff catheter, more flexible for patient
Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
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
Continuous Ambulatory Peritoneal Dialysis (CAPD)
3-4 times during the day and 1 time at night, normal diet, fewer blood transfusions
Principles of Dialysis
Osmosis (L–>H), Hydrostatic pressure (H–>L), temperature (direct relationship with rate), rate of blood flow
Complications from Hemodialysis
Hyper/hypovolemia, hemolysis, Dialysis Disequilibrium Syndrome, transfusion Reaction, Physical Discomfort, Body Image issues, grief, fear dependence
Acute Kidney Injury (AKI)
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
Phases of Acute Kidney Injury (3)
- Oliguric
- Diuretic
- Recovery
Oliguric Phase
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
Diuretic Phase
Urine output starts to increase (7-10days)
watch for dehydration, electrolyte balance, replace fluids, daily weight
Recovery Phase
3-12 months, convalescent phase
