Renal disorders Flashcards
serum creatinine
0.6 - 1.2 mg/dL
⇡ = kidney impairment
older adults = may be ↓
blood urea nitrogen (BUN)
10 - 20 mg/dL
⇡ = liver or kidney disease, dehydration or ↓ kidney perfusion, a ⇡ protein diet, infection, stress
↓ = FVE, malnutrition, or hepatic damage
older adults = 60-90 -> 8-23; >90 yrs -> 10-31
BUN/creatinine ration
6-25
⇡ratio = may be FVD, obstructive uropathy, catabolic state, or ⇡protein diet
↓ ratio = may be FVE
oliguria
< 100-400 ml/day
anuria
< 100 ml/day
azotemia
accumulation of nitrogenous wastes
uremia
azotemia w/clinical symptoms
kidney test/procedure using contrast medium - before
- any reaction to contrast media?
- hx of asthma?
- allergy to seafood, eggs, milk, or chocolate?
- hx of renal impairment
- taking Metformin? (d/c 24 hours before any study using contrast media)
- assess hydration status
nephrotoxic agents
- NSAIDS
- aminoglycosides = -micin antibiotics (vancomycin, amphotericin
- dyes used in x-rays
prerenal causes of AKI
kidney normal - impaired renal blood flow
- renal artery stenosis
- hypovolemic shock (blood or fluid loss)
- BP drugs resulting in hypotension
- infection
- liver failure
- use of aspirin, ibuprofen, naproxen or NSAIDS
- analphylaxis
- severe burns or dehydration
Phases of acute kidney injury (AKI)
- Initiation = insult to kidney –> oliguria
- Period of Oliguria
- ↓ urine output
- ⇡ BUN, creatinine
- occurs 24 hours-week after initial insult
- lasts 10-14 days
NI - daily wt, I/O, hyperkalemia - Period of Diuresis
- ⇡urine output
- lab values stop rising
- may last 1-3 weeks
NI - FVD, hypokalemia - Recovery
- ⇡GFR
- BUN and creatinine stabilize
- Renal function improves for up to a year
NI - monitor for renal failure
S/S - A/N/V, weight gain, malaise, HA
Fluid and electrolytes in AKI
FVE metabolic acidosis K+ = ⇡ Mg+ = ⇡ Ca2+ = ↓ Phosphorus = ⇡ nitrogenous product accumulation = ⇡ BUN, serum creatinine = ⇡
AKI prevention
- adequate hydration
- prompt recognition and treatment of shock
- manage hypotension (maintain MAP of 65 for perfusion of kidneys)
AKI treatment
MONITOR - weight, I/O, VS - electrolytes (K+, Mg+, Na+, Phos) - diuretics - Lasix - treat hyperkalemia - infection and ⇡ temperature NUTRITION - restrict protein; ⇡ carbs - restrict fluids = get losses + 500 ml (to account fo insen
emergency treatment for hyperkalemia
IV
- glucose
- insulin
- sodium bicarb
- calcium gluconate
Acute Glomerulonephritis
- usually caused by an infection (streptococcal)
- manifests about 10 days after infection
clinical manifestations of acute glomerulonephritis
- malaise, HA
- ⇡ BUN, creatinine
- sediment, protein, blood in urine
- CVA tenderness
- ⇡ BP
- ↓ urine output
- specific gravity of urine = 1.010 (fixed no matter how much fluid)
They are retaining fluids and toxins!
Treatment of Acute Glomerulonephritis
Antibiotics Balance rest and activity Daily wts, I/O Monitor BP ↓ protein in diet ↓ sodium in diet may need dialysis Diuresis begins 1-2 weeks after onset (as begin to recover)
Teaching for acute glomerulonephritis pt
Recognize S/S of renal failure:
- HA
- N/V/A
- wt gain
- malaise
- ↓ urine output
Nephrotic syndrome - causes
- bacterial or viral infection
- NSAIDS
- IV drug users
- cancer or genetic predisposition
- systemic disease == lupus, DM
What is nephrotic syndrome?
- ⇡ glomerular permeability that allows larger molecules to pass thru membrane into urine.
- causes massive protein loss, edema (anasarca), and ↓ plasma albumin levels
treatment of nephrotic syndrome
- dialysis
- ACE inhibitors (inhibits aldosterone, so Na+ not retained)
- prednisone (will shrink holes so protein can’t leak out)
- statins (lower lipids)
- ↓ Na+
- ⇡ protein
- anticoags for up to 6 months (b/c lost alot of anticlotting proteins from blood - at risk for thrombosis)
- diuretics (lasix)
- albumin infusion (⇡ oncotic pressure in vascular space; will pull H2O from tissue)
clinical manifestations of Nephrotic Syndrome
- protienuria
- hypoalbuminemia
- edema (anasarca)
- hyperlipidemia
- ↓ urine output
uremia
azotemia with clinical manifestations
- metallic taste in mouth
- A/N/V
- muscle cramps
- uremic “frost” on skin
- itching
- fatigue and lethargy
- hiccups
- edema
- dyspnea
- paresthesias
Diagnosis of CKD
- urine albumin
- ⇡ BUN and serum creatinine
- elevated BP
Labs for CKD
- hyperkalemia
- ↓ Ca, so ⇡ phosphorus
- ⇡ Magnesium (excreted thru kidneys)
- Na+ usually ↓
- metabolic acidosis
- ⇡ triglycerides, ⇡ LDLs
- anemic (eurythropoetin is not being produced by kidneys)
Treatment of CKD
- Hyperkalemia - IV insulin/glucose/sodium bicarb; calcium gluconate
- restrict dietary K+
- Kayexalate - control HTN - CCB, ACE inhibitors (w/caution- ⇡K+)
- mineral and bone disorder - restrict phosphate intake, phosphate binders, Vit D, Cacitrol (keep Ca in bone)
- Complications of drug therapy - can’t be excreted thru kidneys; watch for toxicity
CKD nutrition
Restrict protein Carbs - main energy source Fats - adequate amt Calories - 2000-2500/day Ltd water (500ml + urine output)
nursing care r/t fistula
- NO I/V, venipuncture, restraints, or BP in that arm
- Palpate for thrills Q4H
- Auscultate for bruits Q4H
- Assess distal pulses
- Assess for complications
- Encourage ROM
- Teach:
- do not carry heavy objects or compress arm
- do not sleep w/body wt on extremity
which meds should be held before dialysis?
- antibiotics
2. vasodilators (BB, CCB, ACE inhibitors, ARBs)
which meds can continue w/dialysis?
- antiarrhythmics
- sedatives (versed, propofol, phenobarbitol)
Disequilibrium syndrome
Due to rapid changes in ECF, urea, Na+ and other solutes ==> cerebral edema
S/S = N/V, confusion, restlessness, HA, fatigue
hemodialysis complications
- hypotension
- muscle cramps
- loss of blood
- sepsis/Hep B and C
- HIV
Complications with Peritoneal Dialysis
- infection /peritonitis (abdominal pain) = effluent would be cloudy
- protein loss (so PD pt ⇡ protein!)
- pulmonary complications (fluid pushes on diaphragm)
- hyperglycemia (dialysate is ⇡ in glucose)
- hernia
kidney transplant - donor criteria
- must be a match
- no systemic diseases or infection
- no hx of cancer
- no HTN or kidney disease
- adequate kidney function
kidney transplant - immunosuppressive therapy
- drugs used: prednisone, azithioprine (Imuran), cyclosporine, Prograf
- continues for life of kidney
- dosage may be tapered or altered
- monitor for rejection/infection
- leukocyte, platelet counts are monitored
kidney transplant - rejection
3 types:
- hyperacute - w/in 24 hours
- acute - w/in 1 week - 2 years after transplant
- chronic - occurs over months-years
Treatment of hyperacute rejection
remove kidney
Treatment of acute rejection
more immunosuppressives
Treatment of chronic rejection
treatment is supportive
hyperacute s/s
- ⇡ temp
- ⇡ BP
- pain at site
acute s/s
- oliguria or anuria
- ⇡ BP
- ⇡ temp
- enlarged, tender kidney
- lethargy
- ⇡ serum creatinine, BUN, K+
- fluid retention
chronic rejection s/s/
- gradual increase in BUN and serum creatinine
- fluid retention
- changes in serum electrolyte levels
- fatigue
