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Renal Disorders Flashcards

1
Q

The Kidney

A

Recieves 20-25% Cardiac Output

Cleans blood to maintain homestasis

Regulation of Erythropoietin and Renin/Angiotensin

Vit D Activation

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2
Q

How Does the Kidney Maintain Homesostasis

A

Maintain Blood Volume-Excrete excess

Selective Re-Absorption (Na, K, etc)

Excretion of waste products

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3
Q

Why are Kidney’s Important to RTs

A

Blood volume increases may cause pulmonary edema

Electrolyte disturbanced may manifest in cardiopulmonary symptons (ex. arrhythmias)

Metabolic acidosis

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4
Q

Classification of Renal Disorders

A

Acute Kidney Failure

Chronic Kidney Failure

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5
Q

Acute Kidney Failure

A

State of acute impairment of renal function

Often reversible

Prerenal, renal, and post renal causes

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6
Q

Chronic Kidney Failure

A

Often irreversible

Divided into 5 stages

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7
Q

Normal BUN Levels

A

7-20

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8
Q

Normal Creatine

A

Men <1.4

Women <1.2

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9
Q

Acute Renal Failure Stages

A

Stage 1: Glomerular Filtration Rate will remain normal for a long time and only start to increase as entering into stage 2

Stage 2: GFR decrease and there is an abnormal increase in BUN

Stage 3: GFR will continue to decrease and BUN will continue to increase

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10
Q

Prerenal Etiology

A

Any disease that leads to inadequate perfusion of the kidney where tubular and glomerular function remain normal

Shock

Heart Failure

Hypotension

Sepsis

Atherosclerosis of renal artery

Rhabdomyolysis

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11
Q

Renal (Intrinsic) Etiology

A

Any disease that leads to actual damage of the nephron of the kidney

Acute tubular necrosis

Acute Glomerulonephritis

Acute Interstitial Nephritis

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12
Q

Acute Tubular Necrosis

A

Direct damage to the kidney tissue, especially the tubule

Ischemic or cytotoxic in origin

A cmomon cause of kidney failure in hospitalized pt

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13
Q

Acute Tubular Necrosis Causes

A

Blood Transfusion

Low perfusion for >30 min

Major surgery

Septic shock

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14
Q

Acute Glomerulonephritis

A

Vascular in origin

The glomerulus become inflamed and damaged

Often due to auto-immune response or infection

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15
Q

Acute Interstitial Nephritis

A

Inflammation of the kidney

Often caused by a medicine

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16
Q

Postrenal Etiology

A

Mechanical obstruction of the urinary collecting system (ureter, bladder, urethra. Will increase tubular pressure and the decrease filtration driving force

Stone disease

Tumor

Stricture

Thrombosis

Compressive hematoma

Enlarge prostate

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17
Q

Acute Clinical Manifestations Clinical Manifestations

A

Can vary widely depending on etiology

  • General Commonalities
    • Impact on urine output (oliguria or anuria)
    • Fluid overload-Leading to pulmonary edema
    • Electroyte imbalance
    • Weakness due to electrolyte abnormalities
    • Nausea and vomitting
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18
Q

Oliguria

A

Failure to produce adequate urine

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19
Q

Anuria

A

Total failure to produce urine

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20
Q

Acute Renal Failure Pathophysiology

A

Initial kidney insult-Decrease urine output where the other kidney will try to compensate

Retention of nitrogen wastes leading to fluid overload and increased extra cellular fluid

Renal acidosis

Electroylte imbalances

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21
Q

Acute Renal Failure

Nitrogen Waste

A

Urea, uric acid, and creatinine

22
Q

Acute Renal Failure

Renal acidosis

A

Kidneys cannot excrete fixed acid

Acid/base dsyfunction

23
Q

Acute Renal Failure

Electrolyte Imbalance

A

Common

Hypernatremia, Hyperkalemia, hyperchloremia

24
Q

Normal Urine Lab Findings

A

Yellow to Amber in color

Specific Gravity 1.010-1.025

pH 4.6-4.8

Rarely showing RBC, WBC, epithelial cells, and casts

25
Pathological Urine Lab Findings
Increased BUN or Creatine Urinanalysis may reveal sedimentation, WBC, and RBC
26
Acute Renal Failure Management
* Treat cause * Restore circulation with volume expanders, vasopressors, blood volume * restore circulation to kidney remove neoplasms, clear obstructions * Monitor for fluid overload * Monitor electroyltes particularly K+ level * Monitor for anemia-Kidney produce erythopoetin whic commands stem cell in marrow to form RBC * Beware inefficent drug elimination * Medication cleared by kidney will linger longer
27
Dialysis Types
Peritoneal CRRT Hemodialysis
28
Peritoneal Dialysis
Tube inserted into the abdomen and a dialysis is exchanged
29
Dialysis-Continuous Renal Replacement Therapy
An extracorpeal purification therapy to substitute for impaired renal function over an extended period of time "Slow" dialysis that has less dramtic swings in fluid balance-better suited for the ICU patient
30
Hemodialysis
Usually 3 weeks A vascular acess is created usually in a foremen A-V fistula (shunt) Inpatients or outpatients
31
Loop Diuretics
Eg. Lasix
32
Potassium-Sparing Diuretics
Aldactone
33
Carbonic Anhydrase Inhibitors
Diamox
34
Thiazide Diuretics
Names that end in zide Hydrochlorothiazide (microzide)
35
Osmotic Diuretics
Mannitol which is very powerful
36
Definition of Chronic Renal Disease
Kidney disease lasting longer than 3 months
37
Chronic Renal Failure Etiology
Most commonly due to-**Diabetes (type 1 and 2) and hypertension** Other causes- Auto-immune diseases, multiple episodes of kidney failure, inflammation, polycystic kidney disease, congenital defects, drugs and toxins
38
Chronic Renal Failure Pathophysiology
Will be categorized into 5 stges based on * Amount of kidney function remaining * Symptons * Estimated glomerular filtration rate (GFR)
39
Chronic Kidney Disease Stage 5
End stage renal disease with severe impairment and starting to not be able to keep the pt alive \<15 ml/min GFR \<15 % kidney function Symptons include poor sleepin, difficultly breathing, itichness, vomitting High levels of creatine and urea are present Start replacement therapy, dialysis, or transplant
40
Chronic Kidney Disease Stage 4
Kideny damage has become so severe and function is so poor that the body struggle to keep the person alive 15-29 ml/min GFR 15-29 % kidney function Symptons include tiredness, poor appetite, and itching plan for dialysis and assessment for transplate
41
Chronic Kidney Disease Stage 3
Even worse kidney damage with less funcion 30-59 ml/min GFR 30-59 % kidney function Early symptons such as tiredness, poor appetite, and itching Creatine levels rise and excess urea is present, and anemia may begin to occur Treatment is totry to slow the disease and discuss further treatment options
42
Chronic Kidney Disease Stage 2
Worsening kidney damage with reduce function 60-89 ml/min GFR 60-89% kidney function No symptons observed Urea and creatine levels are normal or mildly elevated Treatment is to monitor creatine levels, BP, and general health
43
Chronic Kidney Disease Stage 1
Early kidney damage with normal or even increased function 90% kidney function No symptons observed Urea and creatine levels are normal 90 ml/min GFR Treatment is to identify the cause and try to reverse it
44
Chronic Renal Failure Clinical Manifestation
May not have symptons until considerable often irreparable damage has occured ## Footnote Tiredness Poor appetite Itiching **High creatine and BUN levels** **Anemia** Poor sleep/dyspnea Frequent vomitting
45
Chronic Renal Failure Management
Depends on stage of CRF ## Footnote Identify cause and try to stop it Monitor cretaine, BP, and General health Pt Education Dualysis (including creation of access site) Transplant
46
PPV and Renal System
PPV can reduce urinary output Associated with reduction in renal blood flow, glomerular filtration rate, Na and K excretion Decrease mean arterial pressure PPV also has a marked afect on Na and water retaining hormonal system
47
PPV and ADH
ADH is release and is affected by intrathoracic pressure (**PPV enhances ADH release**)
48
PPV and Atrial Natriuretic Factor
PPV reduces atrial filling pressure (decrease atrial strech) causing decreased secretion of ANP
49
PPV and Renin Angiotension/Aldosterone
Renin angiotensin/aldosterone activation leading to increased sodium and water retention
50
Renal System and Decreased CO
Increased intrathoracic pressure will decrease thoracic venous return and in turn decrease CO This will both **increase sympathetic activity** (which causes vasoconstriction) and **decreases renal blood flow** Ultimate result is a decrease glomerular filtration rate and increased soldium and water retention
51
Affect of decreased renal blood flow
Increase vasopressin release RAAS activation Both of the above will decrease GFR and increase NA and water retention

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