renal failure Flashcards
AKI is a rapid ___ in kidney function, leading to the ____ of ____ ____
decrease
collection
metabolic
waste
pre- renal acute kidney injury
decreased blood flow to the kidney
effects of AKI
reduced GFR
damage to nephron cells
obstruction of urine flow
intra- renal acute kidney injury
damage to the glomeruli, interstitial tissue, tubles
post- renal acute kidney injury
obstruction of urine flow d/t stones, or BPH
causes of aki
poor perfusion- hypovolemic shock
toxins
infection
obstruction
in hypoperfusion/ shock, the kidney compensates by ___ renal blood vessels, activating the ____, and releasing ____
constricting
RAAS
ADH
*This will improve kidney perfusion but reduce urine volume and lead to the retention of N in blood
when the pressure in the ____ ____ (__ ___) exceeds ____ ____, the GFR stops. this allows __ to collect in the blood and will increase ___ and serum ____ levels
kidney tubules intra renal pressure glomerular pressure N BUN creatinine
phases of AKI
onset
oliguric
diuretic
recovery
early acute syndrome may be reversible by treatment to
correct blood volume
increase blood pressure
improve CO
Prolonged kidney injury
severe damage and intra- renal damage may occur
oliguria
reduced urine volume
azotemia
retention and build up of nitrogenous waste in the blood
toxins in the kidney cause
blood vessel constriction, leading to reduced kidney blood flow and ischemia
chronic renal failure (CRD)
progressive, irreversible disorder. kidney function does not recover
primary causes of crd
untreated ACF
DM
HTN- end organ damage to the kidney
intra-renal: glomerulonephrities, Systemic lupus erythematous, polycystic kidney disease
____ is staged using ____. the lower the _, the worse the kidney failure.
CRF
GFR
GFR
STAGE 1
kidney damage with normal or increased GFR
Stage 2
kidney damage with mild decrease in GFR
stage 3
moderate decrease in GFR
Stage 4:
severe decrease in GFR
Stage 5
kidney failure
an early complication of CRD is ____, because there are fewer healthy nephrons to reabsorb ___, which can also cause p____
hyponaterima
Na
polyuria
later in CRD excretion of sodium is ___ as urine production ____, so ____ occurs even with only modest increases in the diet
reduced
decreases
HYPERnatremia
late in CRD there is ______, so these changes in potassium cause EKG changes and ____
hyperkalemia
dysrhythmias
affect of CRD on pH: early stages
little changes because the remaining nephrons increase acid excretion
as more ___ are lost in the later stages of CRD, ___ cannot be excreted as much, so __ occurs
nephrons
acid
acidosis
in CRD ___ production decreases, and bicarb ___ doesn’t really occur so it is even more ____
ammonium
reabsorption
acidic
kidney changes with CRD
- healthy nephrons become larger and work harder
- poor water excretion
- abnormal urine production
- electrolyte imbalances
- metabolic abnormalities
normally the kidney excretes excessive ____. it is controlled by ____
phosphate
parathyroid hormone
early in CKD there is ___ secretion of phosphorus, which leads to a ___ of _ levels. this in turn results in __ levels decreasing
reduced
increase
phosphourus
ca
____ controls phosphate in the blood by causing tubular ____ in excess
PTH
excretion
chronic low levels of ca, cause the parathyroid gland to release more ___. calcium then comes from ___ ____ and can lead to ____ ____ ___ “renal __”
PTH
bone reabsorption
bone density loss
“renal osteodystrophies”
the decrease in kidney function leads to metabolic abnormalities like ___ (from protein metabolism) and ___ (from protein in skeletal muscle) build up
urea
creatinine
BP is ____ by causing ___ and __ overload, and dysfunction of the ____
elevated
fluid
sodium
RAAS
the heart is ___ due to long term stress
enlarged
hyperlipidemia occurs due to changes in __ metabolism that increase ____, total ____, and __ levels
lipid
triglycerides
cholesterol
LDL
*Pt is more at risk for CAD and acute cardia events
___ occurs in the late stages of CKD and worsens manifestations. d/t decreased ___, RBC dies because of uremia, __ deficiency, and __ because of poor platelet function
anemia
erythropoietin
iron
bleeding
uremia is ___ in blood. this affects the entire ___. the normal flora of the mouth changes, there is ___, N/V, and ____
urea
GI
anorexia
hiccups
uremia causes changes to the GI and can cause
peptic ulcer disease
uremic cholitis
erosion of blood vessels in the stomach, small intestine, large intestine-> blood loss -> hemorrhagic shock
uremic cholitis
watery diarrhea and colitis
CM of CKD
neurological respiratory cardiovascular GI skeletal urinary skin *d/t changes in fluid volume, electrolyte and acid base imbalance, N waste build up*
neuro sx of CKD
lethargy
seizures or coma
encephalopathy
weakness in extremities
cardio sx of CKD
fluid overload HTN CHF pericarditis K+ induced dysthrythmias
respiratory sx of CKD
halitosis- breathe smells like urine deep sighing yawning SOB severe metabolic acidosis= kussmal's breathing
hematologic sx of CKD
Anemia and abnormal breathing causing: fatigue pallor lethargy weakness SOB dizziness
GI sx of CKD
Foul breath
mouth ulcerations
mouth inflammation
Skeletal sx of CKD
thin fragile bones= increased risk for fractures
break easily with slight trauma
compact vertebrae, bend forward, loss of height
urinary sx of CKD
Dilute, clear urine because of tubular reabsorption of water reduced
end stage= oliguria
skin sx of CKD
yellowish discoloration due to uremia
potiential complications of Chronic renal failure
HTN and edema uremia anemia metabolic acidosis hypocalcemia hyperphosphatemia encephalitis (end stage)
treatment of end stage renal disease
hemodialysis peritoneal dialysis kidney transplant diet modification medication modification
dialysis
removes excess fluids and waste products; restores chemical and electrolyte balance
diet modification for pt in end stage renal disease
control protein intake
limit fluid intake
restrict na, k, p
supplements of vitamin d, calcium and iron
