Renal Disorders Flashcards
Functions of the Renal System
Filters waste products
Regulations ion levels
Regulated blood pH
Conserves valuable nutrients
Regulates blood volume
Regulates RBC production
Glomerular Filtration Rate
Flow rate of filtered fluid (blood) through the kidney over time using creatinine clearance to estimate
Nephron
Functional unit of the kidney
- Filtration
- Tubular Reabsorption
- Tubular Secretion
- Excretion
Acute Kidney Injury
An abrupt decrease in renal function sufficient to cause retention of metabolic waste
Associated with:
- Metabolic Acidosis
- Hyperkalemia
- Disturbance in fluid homeostasis
Oliguria
Daily urine output <400 mL
When present in acute renal failure … increased mortality
Anuria
No urine production (this is really, really bad…)
Most common community acquired ARF:
Prerenal (heart failure)
Most common hospital acquired ARF:
Acute Tubular Necrosis (ATN)
Causes of ARF: Pre-renal
Conditions that decrease RBF
- Heart Failure
- Shock
- Sepsis
- Hemorrhage
- Hypovolemia
Causes of ARF: Post-renal
Conditions that obstruct and/or disrupt urine outflow
- Kidney stones
- Prostatic hypertrophy
- Cancers of the bladder, prostate, or cervix
- Blood clots
Causes of ARF: Intra-renal
Injury or inflammation to the kidneys
- Interstitial nephritis
- Acute glomerulonephritis
- Acute tubular necrosis
- Ischemia
- Toxins
Urinary Drainage System Obstruction
Leads to dilation of urinary tract proximal to the obstruction
Chronic Renal Failure (CRF)
Diabetic Nephropathy
Hypertension
Glomerulonephritis
Polycystic Kidney Disease
Kidney Infections
Kidney Obstructions
Renal Vascular Disease
Chronic Renal Failure
Glomerular damage:
- Fibrosis and wall thichening
- Altered permeability
Sclerotic changes to renal blood supply
-Ischemia leads to tubular artophy and interstial fibrosis
Temporary Access (Hemodialysis)
A catheter is placed in a central vein, such as the internal jugular vein
Least durable
AV Fistula (Hemodialysis)
Surgeon constructs access by combining an artery and a vein
3 to 6 months to mature
AV graft (Hemodialysis)
Man-made tube inserted by a surgeon to connect artery and vein
2 to 6 weeks to mature
Less durable than AV fistula
Continuous Renal Replacement Therapy (CRRT)
Consists of continuous veno-venous or arterio-venous hemodialysis (like days…)
Peritoneal Dialysis
Uses the peritoneum as the semipermeadble membrane and the diasylate is infused directly into the abdomen
Therapy is generally held during infusion and removal
Dialysis Realted Problems
Hypovolemia
Lightheaded
Hypotension
Dysrhythmias
Disequilibration Syndrome
Therapy Implications
Mobilization activities are typically contraindicated
Expect fluid and electrolyte imbalances (modify plan)
Expect potential dehydration, hypovolemia, hypotension, and fatigue
Monitor hemodynamic status and vitals
Avoid placement of blood pressure cuff over HD access
