Renal Failure Flashcards
Acute renal failure caused from:
- Trauma
- Infection
- Decreased CO
- Dehydration
- Drugs
Acute renal failure S&S
- Anorexia
- Lethargy
- Nausea
- HA
2 types of antibiotics that can cause renal damage
- Aminoglycosides
- Cephalosporins
Aminoglycosides:
Inhibits protein synthesis in Gram (-) bacteria
- Neomycin
- Streptomycin
- Tobrax
- Amican
Cephalosporins
Inhibits synthesis of bacterial cell wall
- Keflex
- Ceclor
- Rocephin
- Maxipime
NSAIDs can cause:
Vasoconstriction that then leads to pre-renal failure
That can lead to interstitial nephritis
If your patient has severe renal disease with oliguria and azotemia, the doctor should order:
Lasix
What is azotemia?
Abnormal high levels of nitrogen in the blood
Avoid heavy metals such as (for renal failure):
- Mercury
- Lead
- Iron
- Industrial pollutants
Always watch which lab result for a patient with renal failure?
-Potassium (K+)
Pre-renal Failure
- Problems affecting the flow of blood before it reaches the kidneys
- Decrease in urinary output due to decreased blood supply to kidney
Renal (Intrarenal) Failure
- Problems with the kidney itself that prevent proper filtration of blood or production of urine
- Decrease in urinary output due to kidney damage to tissues or nephrons
Postrenal Failure
-Problems affecting the movement of urine out of the kidneys
Pre-renal Failure Urinary Output
<400 mL/day
Causes of pre-renal failure
- Dehydration - Hypovolemia (Low BP):
- V/D
- Diuretics
- Blood loss or disruption to the kidneys
- CHF
- Hypoprofusion:
- Low CO
- Cardiac disorders
- Renal artery disease
- Hepatorenal syndrome
Intrarenal Failure Urinary Output
<400 mL/day
Intrarenal (Renal) Failure is also known as:
Acute Tubular Necrosis (ATN)
Causes of Intrarenal (ATN) Failure
- Ischemia
- Nephrotoxic substances (drugs) `
Intrarenal (ATN) Failure causes of ischemia:
- Hemorrhage
- Burns
- Sepsis
- HF
- Transfusion reactions
Intrarenal (ATN) Failure causes of nephrotoxicity:
- Heavy metals
- Medications
- Street drugs
- Contrast dye - x-rays
- Tissue breakdown
3 stages of Acute Tubular Necrosis
- Oliguric
- Polyuric
- Recovery
Oliguric Stage of ATN
- Lasts 10-17 days
- Increased: BUN, Creatinine, K+
- Fluid overload
- CHF
- Peritoneal dialysis
Polyuric Stage of ATN
- Last 2 weeks - 3 months
- Increased: BUN & Creatinine
- Low K+
- Fluid depleted
Recovery Stage of ATN
- Lasts 3 months - 1 year
- Pray the kidney regenerates
Urinary Na+: Pre-Renal vs. ATN
Pre-Renal: 20
ATN: 40-100
BUN:Creatinine - Pre-renal vs. ATN
Pre-renal: 20:1
ATN: 10:1
Lasix/Fluid Challenge: Pre-renal vs. ATN
Pre-renal: + urine
ATN: No urine
Your MEDICAL client has a urine output of 20 mL for 2 hours.
What do you think would be ordered to increase urine output?
-Lasix
Your SURGICAL client has a urine output of 20 mL for 2 hours.
What do you think would be ordered to increase urine output?
-Fluid challenge or -500 mL of NSS or -Both
Post-Renal (Obstructive) Failure causes:
- Stones
- Clots
- Tumors
-(Rare; 5-10%)
Blood & Urine tests for renal failure patients
- 24 hour urine collection for creatinine clearance
- K+
- Na+
- Glucose
- Hct
Medical Management of renal failure patients
- Fluids and osmotic preparations to prevent decreased renal perfusion
- Managing fluid volume and electrolytes
- Diet
- Drug therapy
The Renal Diet
LOW:
- Phosphorus
- K+
- Protein
- Na+
- PO intake of fluids
Foods a renal failure patient should avoid:
- Cola
- Peanut butter
- Sardines
- Nuts
- Beer
- Meat
- Milk products, ice cream, cheese
- Eggs
- Anything salty
- Condiments
- Canned soup, vegetables, prepared dinners
- Anything that melts at room temperature
Classic hyperkalemia sign:
Muscle weakness
Your renal patient c/o dry mouth due to fluid restrictions.
Your suggestion?
- Ice chips
- Sips of water
- Hard candy
Causes of chronic renal disease:
-Diabetic nephropathy (Intrarenal) 43%
