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Patho Exam 4 > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

Basic functions of the kidney

A

Secretion of erythropoietin to stimulate RBC production
Endocrine control of calcium and phosphate
Endocrine regulation of ECF
Excretion of nitrogenous waste products (urea, uric acid)
Water, electrolyte and acid base homeostasis

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2
Q

Glomerular filtration

A

filtering the blood that flows through the kidney’s good vessels or glomeruli

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3
Q

Tubular reabsorption

A

reabsorbing filtered fluid through the tubules that make up the kidney (pull fluid from the tubules back into the blood stream)

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4
Q

Tubular secretion

A

release of filtered substances from the blood, to the tubules and secreted as urine

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5
Q

What are some diagnostic tests you can do for kidneys?

A

radiograph/ultrasound
Check serum abnormalities
Low plasma pH
Anemia (chronic kidney failure)

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6
Q

What happens to the electrolyte balances in diminished renal function?

A

you will have nL or elevated levels of K

you will have decreased levels of Ca and increased levels of phosphorus (they always move opposite)

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7
Q

What would the ABGs indicate in diminished renal function?

A 
decreased arterial pH and bicarb levels
Metabolic acidosis (renal....not lung)
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8
Q

When kidneys aren’t working well what happens to the BUN?

A

rises (even though it is is a poor indication of renal failure)

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9
Q

What happens to creatinine levels when kidneys aren’t working well?

A

Creatinine is not being reabsorbed or secreted by the tubules so the creatinine levels rise! It’s specific because it only rises if problems with the kidney, but you must compare it to a person’s normal levels and it is NOT sufficient by itself for measuring renal function

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10
Q

What is the normal BUN:Creatinine Ratio and what is indicative of renal dysfunction

A

Normally 10:1 but in renal failure it >20:1

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11
Q

Azotemia

A

accumulation of nitrogenous waste in blood (urea, creatinine and others)….spilling of these wastes into the blood stream.

**When azotemia = renal failure

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12
Q

Do men have higher or lower creatinine levels than women

A

they always have higher levels, thats why it is important to know what the person’s nL level of creatinine is

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13
Q

What is creatinine clearance used for?

A

It’s done to see if someone’s kidneys are working, and is the amount of blood (mL) that the kidneys can clear of creatinine in 1 minute
(how much creatinine shows up in urine)

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14
Q

What does creatinine clearance measure?

A

most accurate measure of glomerular filtration rate (GFR) because creatinine is filtered by the glomeruli, but not reabsorbed by the tubules

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15
Q

Glomerular filtration rate is a function of

A

permeability of the capillary walls
vascular pressure
filtration pressure

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16
Q

What is the normal GFR rate?

A

120 mL/min (rate at which the glomeruli filter blood)

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17
Q

What is the relationship between GFR and Creatinine Clearance?

A

Since tubules don’t reabsorb or secrete creatinine the creatinine clearance is = GFR

NOTE **if the tubules were to reabsorb the substance Clearance < GFR
and if the tubules secreted the substance the Clearance would be > GFR

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18
Q

Is it better to have increased or decreased creatinine levels in urine?

A

It’s better to have increased because it indicates that the kidneys are functioning properly (not reabsorbing creatinine)

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19
Q

What is the GOLD standard test for Renal function?

A

CREATININE CLEARANCE

It’s a 24 hour collection

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20
Q

What would the CBC test indicate if there was renal dysfunction/failure?

A

Decreased RBCs
Decreased Hgb
Low Hct (25-35%) (if anaphoric = 1 kidney or no kidneys it would be really low @ 12-20%)
Microcytic hypochromic anemia (what iron deficiency anemia looks like)

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21
Q

Causes of chronic kidney disease?

A

Obstructions - kidney stones
Chronic infections - pylonephritis and tuberculosis
HTN and diabetes
Glomerular disease

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22
Q

Stage I chronic kidney disease

A

kidney damage with normal or increased GFR

>90ml/min/1.73m2

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23
Q

Stage 2 chronic kidney disease

A

Mild reduction in GFR

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24
Q

Stage 3 chronic kidney disease

A

Moderate reduction in GFR

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25
Q

Stage 4 chronic kidney disease

A

Severe reduction in GFR

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26
Q

Stage 5 chronic kidney disease

A

KIDNEY FAILURE and person needs treatment in order to live (GFR <15ml)

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27
Q

Symptomatic indications of Chronic Renal Disease?

A 
hyperphosphatemia
pruritis (itchy dry skin with yellowish grey color)
Anemia and bleeding tendency
bone pain
acidosis
tiredness
nocturia
fluid overload
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28
Q

Compensation of tubular functions of kidney failure include

A

Inability to excrete potassium (increased K)
Inability to regulate sodium excretion (decreased Na)
Hyperphosphatemia and hypocalcemia = increased levels of PTH (PTH pulls Ca out of the bones and the bones become weaker and they break)

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29
Q

How does CKD change the kidney function?

A

Impairs synthesis of erythropoietin and effects of uremia = ANEMIA

Impairs platelet function = BLEEDING TENDENCIES (bruising/bloody noses)

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30
Q

Why is anemia a result of CKD and how do you treat it?

A

shortened lifespan of RBCs and the decreased production of erythropoietin = low RBCs = low o2

TX Epogen (synthetic erythropoietin) or dialysis to remove uremic toxins

31
Q

Are people with CKD prone to infection?

A

yes because they have decreased immune responsivness

32
Q

Cardiovascular alterations d/t CKD

A

HTN
Edema
CHF; pulmonayr edema
Uremic pericardidits (metabolic waste products damage the pericardial sac)

33
Q

Why is HTN result for CKD?

A

the R-A-A system is activated d/t not enough blood in the kidney (renal ischemia)
This causes vasoconstriction and can lead to fluid overload = HTN –>LVH—>CHF

34
Q

Hypertensive encephalopathy and how it’s related to CKD?

A

increased ICP causes circulating wastes to damage brain tissue = headaches, retinal changes, seizures, comas

35
Q

How does hyperkalemia effect the heart during CKD?

A

the increased K causes the heart to have a dangerous rhythm (Acidosis/ion shift) which could lead to arrhythmia (V-fib) and EKG changes (high peaked T prolonged p-r)

36
Q

GI function and CKD

A

increased metabolic wastes = anorexia, and vomiting

decreased pot function and increased gastric secretion d/t hyperparathyroidism = GI bleeding

37
Q

Neurologic changes and CKD?

A

Fluid and electrolyte imbalance and increase in metabolic acids
CSF and fluid overload can occur

38
Q

Neurologic s/sx and CKD?

A

Decreased concentration and attention span
Increased irritability
Burning feet and gait changes (foot drop)
Muscle cramping
Abnormal EEG

39
Q

What are the 2 bone problems (osteodystrophy) with CKD

A

ostetis fibrosa - high bone turnover
osteomalacia - low bone turnover

*Both result in muscle weakness, bone pain/tenderness, and spontaneous fractures

40
Q

ostetis fibrosa

A

high bone turnover = low levels of vit D and hyperphosphatemia

41
Q

osteomalacia

A

low bone turnover = aluminum intoxification

42
Q

How will the skin look with CKD

A

extracellular calcifications
dry skin and mucous membranes (scaly skin)
pale sallow complexion (yellow/grey color)
pruritus
odorous urine and breath

43
Q

What causes changes in skin with CKD?

A

Calcium and phosphate levels
Anemia
High concentration of metabolic end products in body fluids

44
Q

Calciphylaxis

A

fatal syndrome of vascular calcification, thrombosis and SKIN NECROSIS
Necrotic skin appears bluish purple or completely black leathery lesions

45
Q

What happens to the GU system with CKD?

A

Impotence and loss of libido
Amenorrhea
d/t decreased testosterone and estrogen levels

46
Q

What kind of Diet should you eat with CKD?

A

Need a diet with complete proteins that contain all essential amino acids
Low sodium and Low potassium
Fluid restriction to maintain fluid balance

47
Q

What kind of medications do they give for CKD?

A

Diuretics
Antihypertensives (controls BP)
Alkalizing agents (treats metabolic acidosis)
Cation exchange (Na for K to treat hyperkalemia

48
Q

What are the 2 most common reasons for Stage 5 Kidney disease

A 
#1  DIABETIC GLOMERULOSCLEROSIS
#2 HYPERTENSIVE NEPHROANGIOSCLEROSIS
49
Q

Hemodialysis (artificial kidney)

A

separating elements in a solution by diffusion across a semi-permeable membrane down the concentration gradient
semipermeable membrane through which blood is circulated

Removed end products of nitrogen metabolism
Replenishes bicarb

50
Q

What doe hemodialysis do?

A

it removed accumulated Na and water

51
Q

What is given to prevent clotting in hemodialysis?

A

heparin

52
Q

How long does hemodialysis usually take

A

3-6 hours

53
Q

What area of the body can an IV access for hemodialysis take place?

A

Subclavian
Arterio-venous fistula
Internal jugular
Arterio- Venous graft

54
Q

How do you know what dialysate to give people in hemodyalisis

A

ITS DEPENDENT ON THE PERSON - each person has his/her own recipe for what they may need

**we want to be pulling out creatinine

55
Q

How does creatinine get pulled out during diaylysis

A

urea and creatinine move from the blood into the dialysate solution d/t concentration gradients

**BLOOD, CELLS, AND PLASMA PROTEINS stay on the blood side because they are toooo large

56
Q

What is the rate of flow in dialysis

A

As the temperature increases, the rate of diffusion speeds up and osmosis increases too
**blood is pumped out of pt and the dialysate is pumped through the machine and comes in contact with the blood that is constantly moving through the system

57
Q

What are some potential complications of hemodialysis

A

HYPOVOLEMIA (excessive filtration)
hypervolemia
hemolysis (wrong dialysate/high temp can rupture RBCs)
dialysis disequilibrium syndrome

58
Q

What is a major risk of hemodialysis?

A

HYPOVOLEMIC SHOCK

59
Q

What id dialysis disequilibrium syndrome

A

urea and creatinine do not get pulled as quickly from the CSF and they create an osmotic gradient which pulls water into the CSF = cerebral edema, and increased ICP, nausea, convulsions, coma

60
Q

What is peritoneal dialysis

A

AMBULATORY - peritoneal works like a kidney

done 3-4x a day and a fresh bag of dialysate is drained into the abdomen where it dwells for 4-6 hours and then it it drained and the cycle repeats

61
Q

What is Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)

A

the new and improved version….automated cycler is used to perform 3-5 exchanges during the night. In the morning one dialsylate exchange dwells for the entire day.

62
Q

Where is the solution infused in peritoneal dialysis

A

between the visceral and parietal components of the peritoneum using a Tenckhoff catheter

63
Q

What are the major complications of Peritoneal Dialysis

A

PERITONITIS d/t the opening of the peritoneal (can result in scaring and reduce dialysis surface

64
Q

What is a major indication of Acute Kidney Injury

A

any creatinine increase

**if it doubles or triples you are at a huge risk for loss of function

65
Q

Pre-renal causes of AKI

A

ALL ARE D/T LACK OF BLOOD FLOW

Hypovolemia
CV disorders (heart failure, arrhythmia, MI)
Peripheral vasodilation - blood not getting to heart and now not getting back to the kidney
Severe vasoconstriction

66
Q

Post-Renal causes of AKI

A 
DUE TO OBSTRUCTION
Ureteral obstruction
Bladder obstruction
Uretheral obstruction (enlarged prostate/ prosthetic hypertophy)
67
Q

Intra-renal AKI causes

A

Acute tubular necrosis (ischemic damage from poorly treated pre-renal failure = damage to parenchyma)

68
Q

Oliguric Phase of AKI

A

Urinary output 40-400mL (BUN increases and creatine increases)
Infection and heart failure occur d/t hypervolemia, pulmonary edema, hyperkalemia etc.

69
Q

How do you manage oliguric phase?

A

prevention of infection & manage fluids (check daily weights and do oral mouth care so no other germs get in)
Avoid negative nitrogen balance = need to have good protein but NOT TOO MUCH (for tissue maintenance and repair)

For hyperkalemia Mild = give kayexalate
Moderate give hypersonic glucose and insulin
Severe give calcium gluconate, GIK and dialysis

70
Q

What are some things you will see in the oliguric phase of AKI

A 
GI bleeding (nitrogenous waste products cause bleeding)
Anemia
Neurological = convulsions and coma = indicates the need for dialysis
71
Q

Diuretic phase of AKI

A

urinary output progressively increases (doubles each day)

Lasts for 7-14 days

72
Q

Recovery phase of AKI

A

Last 3-12 months and it’s a slow slow process

** want to monitor I and O very carefully

73
Q

Oliguric nursing Responsibilities

A

Administer IV fluids (but watch don’t want to over hydrate)
Accurate I & O (don’t approximate)
Check their weight daily and increase their protein catabolism

Administer:
Kayexale (lowers serum K)
Loop diuretics (Lasix)

74
Q

Diuretic and nursing responsibilities

A 
Diuretic
watch for dehydration and salt depletion
monitor electrolytes 
daily weight 
protein intake may be increased as BUN

Patho Exam 4 (7 decks)

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