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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
Stage 4 chronic kidney disease
Severe reduction in GFR
26
Stage 5 chronic kidney disease
KIDNEY FAILURE and person needs treatment in order to live (GFR <15ml)
27
Symptomatic indications of Chronic Renal Disease?
``` hyperphosphatemia pruritis (itchy dry skin with yellowish grey color) Anemia and bleeding tendency bone pain acidosis tiredness nocturia fluid overload ```
28
Compensation of tubular functions of kidney failure include
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)
29
How does CKD change the kidney function?
Impairs synthesis of erythropoietin and effects of uremia = ANEMIA Impairs platelet function = BLEEDING TENDENCIES (bruising/bloody noses)
30
Why is anemia a result of CKD and how do you treat it?
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
Are people with CKD prone to infection?
yes because they have decreased immune responsivness
32
Cardiovascular alterations d/t CKD
HTN Edema CHF; pulmonayr edema Uremic pericardidits (metabolic waste products damage the pericardial sac)
33
Why is HTN result for CKD?
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
Hypertensive encephalopathy and how it's related to CKD?
increased ICP causes circulating wastes to damage brain tissue = headaches, retinal changes, seizures, comas
35
How does hyperkalemia effect the heart during CKD?
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
GI function and CKD
increased metabolic wastes = anorexia, and vomiting | decreased pot function and increased gastric secretion d/t hyperparathyroidism = GI bleeding
37
Neurologic changes and CKD?
Fluid and electrolyte imbalance and increase in metabolic acids CSF and fluid overload can occur
38
Neurologic s/sx and CKD?
Decreased concentration and attention span Increased irritability Burning feet and gait changes (foot drop) Muscle cramping Abnormal EEG
39
What are the 2 bone problems (osteodystrophy) with CKD
ostetis fibrosa - high bone turnover osteomalacia - low bone turnover *Both result in muscle weakness, bone pain/tenderness, and spontaneous fractures
40
ostetis fibrosa
high bone turnover = low levels of vit D and hyperphosphatemia
41
osteomalacia
low bone turnover = aluminum intoxification
42
How will the skin look with CKD
extracellular calcifications dry skin and mucous membranes (scaly skin) pale sallow complexion (yellow/grey color) pruritus odorous urine and breath
43
What causes changes in skin with CKD?
Calcium and phosphate levels Anemia High concentration of metabolic end products in body fluids
44
Calciphylaxis
fatal syndrome of vascular calcification, thrombosis and SKIN NECROSIS Necrotic skin appears bluish purple or completely black leathery lesions
45
What happens to the GU system with CKD?
Impotence and loss of libido Amenorrhea d/t decreased testosterone and estrogen levels
46
What kind of Diet should you eat with CKD?
Need a diet with complete proteins that contain all essential amino acids Low sodium and Low potassium Fluid restriction to maintain fluid balance
47
What kind of medications do they give for CKD?
Diuretics Antihypertensives (controls BP) Alkalizing agents (treats metabolic acidosis) Cation exchange (Na for K to treat hyperkalemia
48
What are the 2 most common reasons for Stage 5 Kidney disease
``` #1 DIABETIC GLOMERULOSCLEROSIS #2 HYPERTENSIVE NEPHROANGIOSCLEROSIS ```
49
Hemodialysis (artificial kidney)
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
What doe hemodialysis do?
it removed accumulated Na and water
51
What is given to prevent clotting in hemodialysis?
heparin
52
How long does hemodialysis usually take
3-6 hours
53
What area of the body can an IV access for hemodialysis take place?
Subclavian Arterio-venous fistula Internal jugular Arterio- Venous graft
54
How do you know what dialysate to give people in hemodyalisis
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
How does creatinine get pulled out during diaylysis
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
What is the rate of flow in dialysis
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
What are some potential complications of hemodialysis
HYPOVOLEMIA (excessive filtration) hypervolemia hemolysis (wrong dialysate/high temp can rupture RBCs) dialysis disequilibrium syndrome
58
What is a major risk of hemodialysis?
HYPOVOLEMIC SHOCK
59
What id dialysis disequilibrium syndrome
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
What is peritoneal dialysis
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
What is Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
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
Where is the solution infused in peritoneal dialysis
between the visceral and parietal components of the peritoneum using a Tenckhoff catheter
63
What are the major complications of Peritoneal Dialysis
PERITONITIS d/t the opening of the peritoneal (can result in scaring and reduce dialysis surface
64
What is a major indication of Acute Kidney Injury
any creatinine increase | **if it doubles or triples you are at a huge risk for loss of function
65
Pre-renal causes of AKI
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
Post-Renal causes of AKI
``` DUE TO OBSTRUCTION Ureteral obstruction Bladder obstruction Uretheral obstruction (enlarged prostate/ prosthetic hypertophy) ```
67
Intra-renal AKI causes
Acute tubular necrosis (ischemic damage from poorly treated pre-renal failure = damage to parenchyma)
68
Oliguric Phase of AKI
Urinary output 40-400mL (BUN increases and creatine increases) Infection and heart failure occur d/t hypervolemia, pulmonary edema, hyperkalemia etc.
69
How do you manage oliguric phase?
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
What are some things you will see in the oliguric phase of AKI
``` GI bleeding (nitrogenous waste products cause bleeding) Anemia Neurological = convulsions and coma = indicates the need for dialysis ```
71
Diuretic phase of AKI
urinary output progressively increases (doubles each day) | Lasts for 7-14 days
72
Recovery phase of AKI
Last 3-12 months and it's a slow slow process | ** want to monitor I and O very carefully
73
Oliguric nursing Responsibilities
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
Diuretic and nursing responsibilities
``` 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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